Al-Moraissi Essam Ahmed, Ellis Edward
Assistant Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Thamar, Yemen.
Professor and Chair, Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center, San Antonio, TX.
J Oral Maxillofac Surg. 2015 Apr;73(4):606-15. doi: 10.1016/j.joms.2014.10.013. Epub 2014 Oct 22.
The aim of this study was to answer the following question: in patients with nasal bone fractures (NBFs), does closed reduction under local anesthesia (LA) produce comparable outcomes as closed reduction under general anesthesia (GA)?
A systematic review with meta-analysis and a comprehensive electronic search without date and language restrictions was performed in August 2014. The inclusion criteria were studies in humans, including randomized or quasi-randomized controlled trials (RCTs), controlled clinical trials (CCTs), and retrospective studies whose aim was comparing clinical outcomes between LA and GA for closed reduction of NBFs.
Eight publications were included: 3 RCTs, 2 CCTs, and 3 retrospective studies. Three studies showed a low risk of bias, and 5 studies showed a moderate risk of bias. There was no statistical difference between LA and GA for closed reduction of NBFs with regard to patient satisfaction with anesthesia, patient satisfaction with function of the nose, need for subsequent retreatment (septoplasty, septorhinoplasty, or rhinoplasty with refracture), and a patient's chosen treatment for a refracture of the nose. There was a statistical difference between LA and GA for closed reduction of NBFs with regard to patient satisfaction with the appearance of the nose.
Regardless of the cost and risks associated with GA, the results of the meta-analysis showed that GA provides better patient satisfaction with anesthesia, appearance and function of the nose, and preference of treatment for a refracture of the nose. In addition, the meta-analysis showed that GA decreased the number of subsequent corrective surgeries (septoplasty, septorhinoplasty, and rhinoplasty) required.
本研究旨在回答以下问题：在鼻骨骨折（NBF）患者中，局部麻醉（LA）下的闭合复位与全身麻醉（GA）下的闭合复位效果是否相当？
2014年8月进行了一项包含荟萃分析的系统评价，并进行了全面的电子检索，无日期和语言限制。纳入标准为针对人类的研究，包括随机或半随机对照试验（RCT）、对照临床试验（CCT）以及旨在比较LA和GA用于NBF闭合复位临床结局的回顾性研究。
纳入8篇文献：3项RCT、2项CCT和3项回顾性研究。3项研究显示偏倚风险低，5项研究显示偏倚风险中等。在NBF闭合复位方面，LA和GA在患者对麻醉的满意度、患者对鼻功能的满意度、后续再次治疗（鼻中隔成形术、鼻 septorhinoplasty或鼻骨折复位的鼻成形术）的需求以及患者对鼻骨折复位的选择治疗方面无统计学差异。在NBF闭合复位方面，LA和GA在患者对鼻外观的满意度方面存在统计学差异。
无论GA相关的成本和风险如何，荟萃分析结果表明GA在麻醉、鼻外观和功能以及鼻骨折复位治疗偏好方面能为患者提供更好的满意度。此外，荟萃分析表明GA减少了所需的后续矫正手术（鼻中隔成形术、鼻 septorhinoplasty和鼻成形术）的数量。
