Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.
Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.
Int J Oral Maxillofac Surg. 2021 Jan;50(1):83-95. doi: 10.1016/j.ijom.2020.07.022. Epub 2020 Aug 12.
This systematic review aimed to compare the Erich arch bars (EABs) with intermaxillary fixation (IMF) screws in maxillofacial fractures involving dental occlusion on perioperative parameters. Four electronic databases were searched: MedLine (Pubmed), Web of Science, VHL, and Cochrane Library. Inclusion criteria comprised clinical trials comparing the two IMF methods, assessing at least one of the outcomes: occlusal stability, oral hygiene, quality of life, time to apply and remove IMF appliances, and complications. Risk of bias was evaluated through the Cochrane risk of bias tool. Fifteen papers were included in the qualitative analysis and 12 of those in the meta-analysis. Times for EABs application (mean difference (MD) 46.83; 95% confidence interval (CI): 30.63-63.02) and removal (MD 22.89; 95% CI 14.61-31.17) were longer compared with IMF screws. There is higher risk of glove perforation (risk ratio (RR) 3.81; 95% CI 2.41-6.04) and lower risk of iatrogenic injuries (RR 0.21; 95% CI 0.09-0.48) when placing EABs compared with IMF screws. No significant differences in plaque index were found (MD 1.07; 95% CI -0.17 to 2.31). The quality of this evidence ranged from very low to low and was mainly compromised by risk of bias assessment. Further studies are necessary to evaluate transurgical IMF stability and postoperative occlusal quality and quality of life when comparing EABs with IMF screws.
本系统评价旨在比较 Erich 弓（EAB）与颌间固定（IMF）螺钉在涉及牙咬合的颌面骨折中的围手术期参数。四个电子数据库进行了检索：MedLine（Pubmed）、Web of Science、VHL 和 Cochrane Library。纳入标准包括比较两种 IMF 方法的临床试验，评估至少一个结果：咬合稳定性、口腔卫生、生活质量、应用和去除 IMF 器械的时间以及并发症。通过 Cochrane 偏倚风险工具评估偏倚风险。15 篇论文纳入定性分析，其中 12 篇论文纳入荟萃分析。EAB 应用时间（均数差（MD）46.83；95%置信区间（CI）：30.63-63.02）和去除时间（MD 22.89；95% CI 14.61-31.17）均长于 IMF 螺钉。与 IMF 螺钉相比，放置 EAB 时手套穿孔的风险更高（风险比（RR）3.81；95% CI 2.41-6.04），医源性损伤的风险更低（RR 0.21；95% CI 0.09-0.48）。菌斑指数无显著差异（MD 1.07；95% CI -0.17 至 2.31）。该证据质量从极低到低不等，主要受偏倚风险评估的影响。需要进一步研究来评估 EAB 与 IMF 螺钉比较时的手术内 IMF 稳定性以及术后咬合质量和生活质量。
