King Brett J, Christensen Brian J
Assistant Professor, Department of Oral & Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA.
Chief Resident, Department of Oral & Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA.
J Oral Maxillofac Surg. 2019 Jun;77(6):1228.e1-1228.e8. doi: 10.1016/j.joms.2019.01.030. Epub 2019 Jan 30.
The purpose of this study was to compare the time for placement and removal, the effect on the gingiva, and the operator safety of the Stryker Universal SMARTLock Hybrid MMF system (Stryker Craniomaxillofacial, Kalamazoo, MI) with traditional Erich arch bars.
We designed a parallel-group, randomized controlled trial to compare the 2 types of arch bars. Patients with mandibular fractures presenting to our institution were enrolled in the study and randomized into 1 of 2 groups: the Erich arch bar group and the hybrid arch bar group. The primary outcome variable was arch bar placement time. Secondary outcomes were glove tears or penetrations during application, gingival appearance score at removal, loose hardware at removal, removal time, and glove tears or penetrations at removal. The groups were compared using t tests.
We enrolled 90 patients in the study, with 43 randomized to the Erich arch bar group and 47 randomized to the hybrid arch bar group. The mean application time was 31.3 ± 9.3 minutes for Erich arch bars and 6.9 ± 3.1 minutes for hybrid arch bars (P < .0001). Significantly more glove tears or penetrations occurred during application in the Erich Arch Bar group (0.56 ± 0.91 per application) than in the hybrid group (0.11 ± 0.32 per application) (P = .0025). At removal, no difference in overall gingival appearance or amount of loose hardware was noted. The time for removal was significantly less for the hybrid arch bar group (10.5 ± 5.1 minutes vs 17.9 ± 10.7 minutes, P = .0007).
Hybrid arch bars with bone-borne locking screws offer a number of advantages over traditional Erich arch bars and circumdental wires, including shorter placement and removal times and a greater margin of safety for the operating surgeon as shown by significantly fewer glove tears and penetrations.
本研究旨在比较史赛克通用SMARTLock混合式下颌骨骨折固定系统（Stryker颅颌面公司，卡拉马祖，密歇根州）与传统埃里希牙弓夹板在放置和拆除时间、对牙龈的影响以及术者安全性方面的差异。
我们设计了一项平行组随机对照试验来比较这两种牙弓夹板。纳入我院下颌骨骨折患者并随机分为两组：埃里希牙弓夹板组和混合牙弓夹板组。主要观察指标为牙弓夹板放置时间。次要观察指标包括应用过程中手套撕裂或穿透情况、拆除时牙龈外观评分、拆除时固定装置松动情况、拆除时间以及拆除时手套撕裂或穿透情况。采用t检验对两组进行比较。
本研究共纳入90例患者，43例随机分配至埃里希牙弓夹板组，47例随机分配至混合牙弓夹板组。埃里希牙弓夹板的平均应用时间为31.3±9.3分钟，混合牙弓夹板为6.9±3.1分钟（P<0.0001）。埃里希牙弓夹板组在应用过程中手套撕裂或穿透的发生率（每次应用0.56±0.91次）显著高于混合牙弓夹板组（每次应用0.11±0.32次）（P = 0.0025）。拆除时，两组在整体牙龈外观或固定装置松动量方面无差异。混合牙弓夹板组的拆除时间显著更短（10.5±5.1分钟 vs 17.9±10.7分钟，P = 0.0007）。
带有骨内锁定螺钉的混合牙弓夹板相较于传统埃里希牙弓夹板和环绕牙丝具有诸多优势，包括更短的放置和拆除时间，以及术者安全性更高，这表现为手套撕裂和穿透的情况显著减少。
