一项基于随机临床试验的比较传统和虚拟手术规划在正颌手术中有效性的荟萃分析和系统评价。
A Meta-analysis and Systematic Review Comparing the Effectiveness of Traditional and Virtual Surgical Planning for Orthognathic Surgery: Based on Randomized Clinical Trials.
机构信息
PhD Candidate, Department of Oral and Maxillofacial Surgery, College of Stomatology, Guangxi Medical University, Nanning, China; Guangxi Key Laboratory of the Rehabilitation and Reconstruction of Oral and Maxillofacial Research; Guangxi Colleges and Universities Key Laboratory of Treatment and Research for Oral and Maxillofacial Surgery Disease; Medical Scientific Research Center, Nanning, China.
Professor and Department Chair, Department of Orthodontics, College of Stomatology, Guangxi Medical University, Nanning, China.
出版信息
J Oral Maxillofac Surg. 2021 Feb;79(2):471.e1-471.e19. doi: 10.1016/j.joms.2020.09.005. Epub 2020 Sep 9.
PURPOSE
To explore the advantages of virtual surgical planning (VSP) and traditional surgical planning (TSP) to determine whether the current VSP technique is superior to the TSP technique for orthognathic surgery.
METHODS
An electronic search was carried out in the CENTRAL, PubMed, and Embase databases to identify randomized clinical trials (RCTs) that compared the VSP and TSP techniques regarding their surgical accuracy for hard tissue, prediction precision for soft tissue, required time for planning and surgery, cost and patient-reported outcomes.
RESULTS
Eight articles from 5 RCTs, involving 199 patients, were identified. The findings showed that the VSP and TSP techniques were similar in surgical accuracy for hard tissue in the sagittal plane, although the VSP technique was significantly more accurate in certain reference areas, especially in the anterior area of the maxilla. Both the VSP and TSP techniques had significantly better surgical accuracy for the maxilla than for the mandible. The VSP technique showed clinically significantly greater precision for soft tissue prediction in the sagittal plane. Patients who were treated via the VSP technique presented a more symmetrical frontal view, regardless of whether hard or soft tissue was involved. The VSP technique required more time for software planning, but it showed an advantage in time savings when considering the entire preoperative process. Accompanied by the use of an accurate computer-aided splint, the VSP technique could effectively reduce the operative time. Apart from the initial financial investment of software and hardware, the total cost of the VSP technique was similar to that of the TSP technique. Patients who were treated via the VSP or TSP technique showed similar improvements in quality-of-life.
CONCLUSIONS
Currently, the VSP technique has become a good alternative to the TSP technique for orthognathic surgery, especially regarding frontal-esthetic considerations. Studies reporting indicators with good representativeness and sensitivity using an identical comparative method are recommended.
目的
探讨虚拟手术规划（VSP）和传统手术规划（TSP）的优势，以确定 VSP 技术是否优于 TSP 技术用于正颌手术。
方法
对 CENTRAL、PubMed 和 Embase 数据库进行电子检索，以确定比较 VSP 和 TSP 技术在硬组织手术准确性、软组织预测精度、规划和手术所需时间、成本和患者报告结果方面的随机对照试验（RCT）。
结果
从 5 项 RCT 中确定了 8 篇文章，涉及 199 名患者。结果表明，VSP 和 TSP 技术在矢状面上的硬组织手术准确性方面相似，但 VSP 技术在某些参考区域，特别是在上颌前部，明显更准确。VSP 和 TSP 技术对上颌骨的手术准确性都明显优于下颌骨。VSP 技术在矢状面上对软组织预测的手术精度具有显著的临床优势。无论涉及硬组织还是软组织，接受 VSP 技术治疗的患者正面视图更对称。VSP 技术的软件规划需要更多时间，但考虑整个术前过程时，它在节省时间方面具有优势。VSP 技术配合使用精确的计算机辅助夹板，可有效缩短手术时间。除了软件和硬件的初始投资外，VSP 技术的总费用与 TSP 技术相似。接受 VSP 或 TSP 技术治疗的患者在生活质量方面都有相似的改善。
结论
目前，VSP 技术已成为正颌手术 TSP 技术的良好替代方法，特别是在额部美观方面。建议使用具有良好代表性和敏感性的指标，报告使用相同比较方法的研究。
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