From the Departments of Plastic and Reconstructive Surgery and Cranio-Maxillofacial Surgery, University Medical Centre Utrecht/Wilhelmina Children's Hospital; the Department of Plastic and Reconstructive Surgery, Amsterdam University Medical Center, Location VU and AMC; and the Department of Plastic and Reconstructive Surgery, Meander Medical Center.
Plast Reconstr Surg. 2019 May;143(5):1456-1465. doi: 10.1097/PRS.0000000000005510.
Numerous studies have proven the efficacy of mandibular distraction osteogenesis or tongue-lip adhesion in Robin sequence infants with upper airway obstruction. However, none has compared health-related quality of life outcomes.
In the present retrospective study, Robin sequence infants younger than 1 year, who underwent mandibular distraction osteogenesis or tongue-lip adhesion, were included (2006 to 2016). The infants' caregivers were asked to complete a questionnaire based on the Glasgow Children's Benefit Inventory.
The response rate was 71 percent (22 of the 31 questionnaires; mandibular distraction osteogenesis, 12 of 15; and tongue-lip adhesion, 10 of 16) and median age at surgery was 24 days (range, 5 to 131 days). Median total Glasgow Children's Benefit Inventory scores after mandibular distraction osteogenesis and after tongue-lip adhesion were 21.9 (interquartile range, 9.4) and 26.0 (interquartile range, 37.5), respectively (p = 0.716), indicating an overall benefit from both procedures. Positive changes were observed in all subgroups emotion, physical health, learning, and vitality. In syndromic Robin sequence, both procedures demonstrated a lower positive change in health-related quality of life compared with isolated Robin sequence (p = 0.303).
Both surgical procedures demonstrated an overall benefit in health-related quality-of-life outcomes, with no significant differences. The authors' findings contribute to the debate regarding the use of mandibular distraction osteogenesis versus tongue-lip adhesion in the surgical treatment of Robin sequence; however, studies evaluating health-related quality of life in larger Robin sequence cohorts are necessary to identify which procedure is likely to be best in each individual Robin sequence infant.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
大量研究已经证实了下颌骨牵引成骨术或舌唇粘连术治疗上气道梗阻性 Robin 序列婴儿的疗效。然而，目前还没有研究比较过与健康相关的生活质量结果。
在本回顾性研究中，纳入了年龄小于 1 岁且接受了下颌骨牵引成骨术或舌唇粘连术的 Robin 序列婴儿（2006 年至 2016 年）。请婴儿的照顾者根据格拉斯哥儿童福利量表完成一份问卷。
应答率为 71%（31 份问卷中的 22 份；下颌骨牵引成骨术组 15 份中的 12 份，舌唇粘连术组 16 份中的 10 份），手术时的中位年龄为 24 天（范围为 5 至 131 天）。下颌骨牵引成骨术和舌唇粘连术后的中位格拉斯哥儿童福利量表总评分分别为 21.9（四分位距，9.4）和 26.0（四分位距，37.5）（p=0.716），表明两种手术都有整体获益。所有亚组（情绪、身体健康、学习和活力）均观察到阳性变化。在综合征性 Robin 序列中，与孤立性 Robin 序列相比，两种手术方法在健康相关生活质量方面的阳性变化均较低（p=0.303）。
两种手术方法均在健康相关生活质量结果方面表现出整体获益，无显著差异。作者的发现有助于探讨下颌骨牵引成骨术与舌唇粘连术在 Robin 序列手术治疗中的应用；然而，需要更大规模的 Robin 序列队列研究来评估健康相关生活质量，以确定哪种手术方法对每个特定的 Robin 序列婴儿最有效。
临床问题/证据水平：治疗性，III 级。
