Wei Hongpu, Liu Zhixu, Zang Jiajie, Wang Xudong
Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China.
Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2018 Aug;126(2):107-116. doi: 10.1016/j.oooo.2018.02.018. Epub 2018 Mar 7.
There are conflicting views on the postoperative stability of surgery-first and surgery-early approaches in orthognathic surgery. We systematically reviewed the literature to compare the difference in postoperative stability between a surgery-first/early orthognathic approach (SFEA) and a conventional orthodontics-first approach (COA).
PubMed, Embase, and Cochrane Library were searched for studies related to the postoperative stability of SFEA. The primary outcome was the horizontal relapse at the pogonion. Weighted mean differences with 95% confidence intervals were pooled using a random-effects model.
We analyzed 12 studies (total of 498 participants). The pooled estimate suggested that the SFEA group manifested less postoperative stability than COA group (weighted mean difference, 1.50; P < .00001), with moderate heterogeneity (I = 53%). The result of subgroup analysis yielded no subgroup difference. Sensitivity analysis conducted by omitting one study at a time further validated the robustness of the result.
Based on the meta-analysis, the mandible tends to rotate counterclockwise more in the SFEA group, which indicate a poorer postoperative stability than in the COA group. Patient screening and treatment plans should be reviewed carefully to compensate for possible postoperative relapse when adopting SFEA.
关于正颌外科中手术优先和早期手术方法的术后稳定性存在相互矛盾的观点。我们系统回顾了文献，以比较手术优先/早期正颌方法（SFEA）和传统正畸优先方法（COA）在术后稳定性方面的差异。
检索了PubMed、Embase和Cochrane图书馆中与SFEA术后稳定性相关的研究。主要结局是颏前点的水平复发。使用随机效应模型汇总95%置信区间的加权平均差异。
我们分析了12项研究（共498名参与者）。汇总估计表明，SFEA组的术后稳定性低于COA组（加权平均差异，1.50；P < .00001），具有中度异质性（I = 53%）。亚组分析结果未显示亚组差异。通过每次省略一项研究进行的敏感性分析进一步验证了结果的稳健性。
基于荟萃分析，SFEA组下颌骨逆时针旋转倾向更大，这表明其术后稳定性比COA组差。采用SFEA时，应仔细审查患者筛选和治疗计划，以补偿可能的术后复发。
