Yang Le, Xiao Yu-Dong, Liang Yu-Jie, Wang Xi, Li Jing-Yuan, Liao Gui-Qing
Resident, Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China.
Associate Professor, Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China.
J Oral Maxillofac Surg. 2017 Nov;75(11):2422-2429. doi: 10.1016/j.joms.2017.06.002. Epub 2017 Jun 12.
The surgery-first approach (SFA) in orthognathic surgery, performed without presurgical orthodontic treatment, has gained attention, but the results remain controversial. The purpose of this study was to assess the current evidence on stability, efficacy, and surgical results of SFA versus conventional 3-stage method (CTM) orthognathic surgery.
A comprehensive search in PubMed and Web of Science was conducted. A systematic review and cumulative meta-analysis of all comparative studies were performed to assess the 2 strategies (SFA and CTM) using a random- or a fixed-effects model. Outcomes included treatment duration, postoperative stability, surgical movement, and postoperative occlusion.
Ten nonrandomized controlled studies including 513 patients were identified. Compared with CTM, patients in the SFA group benefited from shorter total treatment duration (weighted mean difference [WMD], -5.25; 95% confidence interval [CI], -8.21 to -2.29; P = .0005), similar postoperative stability of the mandible (WMD, 0.35 mm; 95% CI, -0.24 to 0.94; P = .55) and maxilla (WMD, 0.13 mm; 95% CI, -0.35 to 0.60; P = .60), similar surgical movements, and other surgical results.
SFA offers an efficient alternative to CTM with shorter total treatment duration, similar postoperative stability, and other surgical results but longer postoperative orthodontic time.
正颌外科手术中不进行术前正畸治疗的手术优先方法（SFA）已受到关注，但结果仍存在争议。本研究的目的是评估与传统三阶段方法（CTM）正颌外科手术相比，SFA在稳定性、疗效和手术结果方面的现有证据。
在PubMed和科学网进行了全面检索。对所有比较研究进行系统评价和累积荟萃分析，使用随机或固定效应模型评估两种策略（SFA和CTM）。结果包括治疗持续时间、术后稳定性、手术移动和术后咬合情况。
共纳入10项非随机对照研究，包括513例患者。与CTM相比，SFA组患者的总治疗持续时间更短（加权平均差[WMD]，-5.25；95%置信区间[CI]，-8.21至-2.29；P = 0.0005），下颌骨（WMD，0.35 mm；95% CI，-0.24至0.94；P = 0.55）和上颌骨（WMD，0.13 mm；95% CI，-0.35至0.60；P = 0.60）的术后稳定性相似，手术移动和其他手术结果也相似。
SFA是CTM的一种有效替代方法，总治疗持续时间更短，术后稳定性和其他手术结果相似，但术后正畸时间更长。
