Department of Oral and Maxillofacial Surgery, Thamar University, Thamar, Yemen.
Department of Oral and Maxillofacial Surgery, Cairo University, Cairo, Egypt.
J Craniomaxillofac Surg. 2018 Dec;46(12):2164-2175. doi: 10.1016/j.jcms.2018.09.001. Epub 2018 Sep 21.
Evidence on the best surgical approach with the lowest lower lid complications (LLCs) in the treatment of orbital floor (OF) and periorbital fractures (POFs) is limited because of the absence of head-to-head studies. We performed this network meta-analysis (NMA) to compare various surgical approaches in treatment of OFs and POFs, with respect to LLCs.
This NMA based on PRIMSA guidelines studied the incidence of the LLCs among various surgical approaches in the treatment of the OFs and POFs. We searched several databases from 1970 to March 2018. All clinical studies comparing different surgical approaches in treatment of OFs and POFs were included. Outcome variables were ectropion, entropion, scleral show and other complications. Predictor variables were transconjunctival approach (TCA), subciliary approach (SCA), subtarsal approach (STA) and infraorbital approach (IOA). Frequentist NMA was performed using STATA software.
A total of 47 studies with 5267 cases of the OFs and POFs received ORIF using 4 surgical approaches with 6 comparisons were included. TCA significantly reduces the prevalence of ectropion than SCA (OR = 3.54, CI1.28-9.84), but no significant difference was found between TCA and, STA or TCA and IOA. SCA and STA significantly reduce the prevalence of entropion than TCA (OR = 5.02, CI, 1.79-14.06, OR = 0.11, CI, 0.02-0.57) respectively. We found no significant difference between the 6 comparisons with respect to other complications.
This NMA shows that the application of various surgical approaches leads to different incidences of LLCs. While TCA appears to have the lowest overall LLCs rate, STA has lowest rate among the transcutaneous approaches. The choice of an appropriate surgical approach for a given fracture should take these among other factors into consideration. Owing to the limitations of this study, we suggest that the results be interpreted with caution.
由于缺乏头对头研究，关于治疗眶底（OF）和眶周骨折（POF）时并发症最低的最佳手术入路的证据有限。我们进行了这项网络荟萃分析（NMA），以比较各种手术入路治疗 OF 和 POF 时，对下睑并发症（LLCs）的影响。
这项基于 PRISMA 指南的 NMA 研究了各种手术入路治疗 OF 和 POF 时 LLC 发生率。我们从 1970 年到 2018 年 3 月检索了多个数据库。所有比较不同手术入路治疗 OF 和 POF 的临床研究均纳入本研究。结局变量为下睑外翻、下睑内翻、巩膜暴露和其他并发症。预测变量为经结膜入路（TCA）、下睑缘入路（SCA）、下睑板入路（STA）和眶下入路（IOA）。采用 STATA 软件进行了似然比法 NMA。
共纳入 47 项研究，共 5267 例 OF 和 POF 患者接受了 4 种手术入路的切开复位内固定术，共 6 项比较。与 SCA 相比，TCA 显著降低下睑外翻的发生率（OR=3.54，95%CI1.28-9.84），但 TCA 与 STA 或 TCA 与 IOA 之间无显著差异。SCA 和 STA 与 TCA 相比，下睑内翻的发生率显著降低（OR=5.02，95%CI，1.79-14.06；OR=0.11，95%CI，0.02-0.57）。6 项比较中，其他并发症发生率无显著差异。
这项 NMA 表明，各种手术入路的应用导致 LLC 发生率不同。虽然 TCA 似乎 LLC 总发生率最低，但 STA 在经皮入路中 LLC 发生率最低。对于特定骨折，选择合适的手术入路应考虑这些因素及其他因素。由于本研究的局限性，我们建议谨慎解释结果。
