Luo M, Yang X, Wang Q, Li C, Yin Y, Han X
State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Wuhou District, Chengdu, Sichuan, China.
State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Wuhou District, Chengdu, Sichuan, China.
Int J Oral Maxillofac Surg. 2018 Feb;47(2):141-151. doi: 10.1016/j.ijom.2017.09.013. Epub 2017 Oct 23.
Despite developments in bioresorbable fixation over recent decades, controversy remains regarding skeletal stability following the use of this material in orthognathic surgery. This systematic review and meta-analysis investigated evidence from the international literature from studies comparing skeletal stability between bioresorbable and titanium fixation in orthognathic surgery. Key words were searched in MEDLINE, Embase, and Cochrane Library, and relevant journals and reference lists were searched for additional material, up to January 2017. Study quality was assessed with the Newcastle-Ottawa scale. The meta-analysis was performed using RevMan software. Ten cohort studies were included. The meta-analysis showed no statistically significant difference between bioresorbable and titanium fixation (SMD (95% CI)) for maxillary horizontal relapse (maxillary advancement 0.09 (-0.16 to 0.33); maxillary setback -0.04 (-0.64 to 0.56)), maxillary vertical relapse (maxillary elongation 0.15 (-0.31 to 0.61); maxillary impaction -0.30 (-1.10 to 0.50)), mandibular horizontal relapse (mandibular advancement 0.16 (-0.72 to 1.03); short-term mandibular setback -0.33 (-0.82 to 0.15)), and mandibular angular relapse (mandibular clockwise rotation -0.39 (-0.79 to 0.00); mandibular counter-clockwise rotation 0.14 (-0.37 to 0.66)). However, after mandibular setback, titanium fixation showed significantly less relapse in the long-term (0.97 (0.47 to 1.47)). With regard to skeletal stability, bioresorbable fixation is comparable to titanium fixation when used in maxillary setback and mandibular clockwise rotation; however titanium fixation may be preferable in mandibular setback. Further high-quality studies are needed to draw more definitive conclusions.
尽管近几十年来生物可吸收固定技术有所发展，但在正颌外科手术中使用这种材料后骨骼稳定性方面仍存在争议。本系统评价和荟萃分析调查了国际文献中的证据，这些研究比较了正颌外科手术中生物可吸收固定和钛固定之间的骨骼稳定性。在MEDLINE、Embase和Cochrane图书馆中搜索关键词，并在相关期刊和参考文献列表中搜索其他材料，截至2017年1月。使用纽卡斯尔-渥太华量表评估研究质量。使用RevMan软件进行荟萃分析。纳入了10项队列研究。荟萃分析显示，在上颌水平复发（上颌前徙0.09（-0.16至0.33）；上颌后退-0.04（-0.64至0.56））、上颌垂直复发（上颌伸长0.15（-0.31至0.61）；上颌压入-0.30（-1.10至0.50））、下颌水平复发（下颌前徙0.16（-0.72至1.03）；短期下颌后退-0.33（-0.82至0.15））和下颌角度复发（下颌顺时针旋转-0.39（-0.79至0.00）；下颌逆时针旋转0.14（-0.37至0.66））方面，生物可吸收固定和钛固定之间无统计学显著差异。然而，在下颌后退后，钛固定在长期显示出明显更少的复发（0.97（0.47至1.47））。关于骨骼稳定性，生物可吸收固定在上颌后退和下颌顺时针旋转中使用时与钛固定相当；然而，在下颌后退中钛固定可能更可取。需要进一步的高质量研究来得出更明确的结论。
