Dept. of Oral & Maxillofacial Surgery, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, 411018, India.
J Craniomaxillofac Surg. 2019 Oct;47(10):1542-1550. doi: 10.1016/j.jcms.2019.07.009. Epub 2019 Jul 19.
The zygomaticomaxillary complex (ZMC) functions as the main buttress for the lateral portion of the middle third of the facial skeleton and because of its prominent position & convex shape, it is frequently fractured, alone or along with other bones of the midface. The management of the ZMC fractures is debatable as the literature is saturated with various theories. A number of techniques, from closed reduction to open reduction and internal fixation can be effectively used to manage these fractures. Controversies lie right from the amount of fixation (1-, 2-, 3- or 4- point fixation) required to the ideal approach, and there is no conclusive view on its ideal line of management.
To compare Malar asymmetry after 2-point vs 3-point fixation in the treatment of zygomaticomaxillary complex fractures.
Electronic search of Pub Med, Google Scholar, Institutional Library, Email to authors and manual search of various journals.
The following criteria were used to select the studies on 2- point and 3-point fixation methods in Zygomaticomaxillary complex fractures. Inclusion criteria had articles that included clinical studies published in the English language or those having sufficient data in English on 2-point or 3-point fixation in the treatment of zygomaticomaxillary complex fractures between the period of 1st January 2008 to 30th September 2018. While exclusion criteria were articles not published in the English language before 1st January 2008 and after 30th September 2018, any reviews, abstracts, letters to editors, editorials and in vitro studies were excluded. Studies that included patients with craniofacial and secondary deformities were also excluded.
Open reduction and internal fixation using 2-point and 3-point fixation methods in the treatment of Zygomaticomaxillary complex fractures.
Preliminary screening consisted of 757 studies and additional records identified through other sources of 272 studies. Amongst these 1029 studies, 837 studies were excluded after reviewing the titles. A review of abstract further excluded 71 studies, so 34 studies that remained were evaluated to fit the eligibility criteria. On the basis of information on fixation methods and parameters of evaluation of fixation method, 26 studies were further excluded. Thus 8 studies with a total of 823 estimates were included in qualitative synthesis.
Parameters assessed by all the authors varied and hence a standardisation for comparison could not be done.
Five out of eight studies showed that the use of 3-point fixation in the treatment of zygomaticomaxillary complex fractures was superior than 2-point fixation for the same. Hence it can be concluded that 3-point fixation is superior than 2-point fixation in reducing malar asymmetry in zygomaticomaxillary complex fractures.
Future studies with uniform parameters being assessed can be done. 3-point fixation can be used as a standard treatment modality in the effective management of Zygomaticomaxillary complex fractures.
颧骨复合体（ZMC）作为中面部中段外侧部分的主要支撑物，由于其突出的位置和凸形，经常发生骨折，单独或与中面部的其他骨骼一起发生骨折。ZMC 骨折的治疗存在争议，因为文献中充斥着各种理论。许多技术，从闭合复位到切开复位和内固定，都可以有效地用于治疗这些骨折。争议在于所需的固定量（1 点、2 点、3 点或 4 点固定）和理想的方法，其理想的管理路线尚无定论。
比较 2 点固定与 3 点固定治疗颧骨复合体骨折后的颧骨不对称。
电子检索 Pub Med、Google Scholar、机构图书馆、向作者发送电子邮件以及手动检索各种期刊。
使用以下标准选择关于 ZMC 骨折 2 点和 3 点固定方法的研究。纳入标准为 2008 年 1 月 1 日至 2018 年 9 月 30 日期间发表的包括临床研究的英文文章，或在治疗颧骨复合体骨折中包含关于 2 点或 3 点固定的足够英文数据的文章。排除标准为 2008 年 1 月 1 日之前和 2018 年 9 月 30 日之后未以英文发表的文章、任何评论、摘要、致编辑的信、社论和体外研究。还排除了包括颅面和继发性畸形的患者的研究。
使用 2 点和 3 点固定方法进行切开复位和内固定治疗颧骨复合体骨折。
初步筛选包括 757 项研究，通过其他来源额外确定了 272 项研究。在这 1029 项研究中，837 项研究在审查标题后被排除。进一步审查摘要排除了 71 项研究，因此有 34 项研究经过评估符合入选标准。根据固定方法信息和固定方法评估参数，进一步排除了 26 项研究。因此，有 8 项研究（共 823 项评估）被纳入定性综合分析。
所有作者评估的参数不同，因此无法进行标准化比较。
八项研究中有五项表明，治疗颧骨复合体骨折时，三点固定优于两点固定。因此，可以得出结论，三点固定在减少颧骨复合体骨折的颧骨不对称方面优于两点固定。
可以进行具有统一评估参数的未来研究。三点固定可作为治疗颧骨复合体骨折的有效方法，作为标准治疗方法。
