超声骨刀与传统截骨技术在颅颌面外科中的应用比较：系统评价和 Meta 分析。

Piezosurgery versus Conventional Cutting Techniques in Craniofacial Surgery: A Systematic Review and Meta-Analysis.

机构信息

From the Division of Plastic Surgery, the Faculty of Medicine, and Division of Otolaryngology, Dalhousie University.

出版信息

Plast Reconstr Surg. 2022 Jan 1;149(1):183-195. doi: 10.1097/PRS.0000000000008645.

DOI:10.1097/PRS.0000000000008645

PMID:34936620

Abstract

BACKGROUND

Despite its increasing use in craniofacial surgery, the evidence for piezosurgery over conventional bone-cutting techniques has not been critically appraised. The purpose of this systematic review and meta-analysis was to identify and assess the evidence that exists for the use of piezosurgery in craniofacial surgery.

METHODS

A systematic review was undertaken using a computerized search. Publication descriptors, methodologic details, and outcomes were extracted. Articles were assessed using the methodologic index for nonrandomized studies and Cochrane instruments. Random effects meta-analysis was completed.

RESULTS

Thirty-nine studies were included. Most studies were published within the past 5 years (51.3 percent) and were randomized controlled trials (56.4 percent). The mean age of patients was 27 years (range, 0.2 to 57 years), and the mean sample size was 44 (range, 12 to 180). Meta-analysis revealed that compared to conventional instruments, piezosurgery had a lower postoperative incidence of sensory disturbance, principally in mandibular procedures (OR, 0.29; 95 percent CI, 0.11 to 0.77; p = 0.01) and pain at postoperative day 3 (mean difference, -0.86; 95 percent CI, -1.20 to -0.53; p < 0.01). There was no statistically significant difference in operating room time (mean difference, 8.60; 95 percent CI, -1.27 to 18.47; p = 0.80) or osteotomy time (mean difference, 0.35; 95 percent CI, -2.99 to 3.68; p = 0.84). Most studies were clinically homogenous (92 percent) and of high quality based on the methodologic index for nonrandomized studies instrument (84 percent). Few studies had domains at high risk of bias based on the Cochrane instrument (28.6 percent).

CONCLUSIONS

Piezosurgery has considerable benefits when compared to conventional instruments. Future studies should investigate its cost-effectiveness and benefits in terms of blood loss, edema/ecchymosis, and patient satisfaction.

摘要

背景

尽管在颅面外科中越来越多地使用，但是Piezo 手术相对于传统的骨切割技术的证据尚未得到严格评估。本系统评价和荟萃分析的目的是确定和评估 Piezo 手术在颅面外科中的应用证据。

方法

使用计算机检索进行系统评价。提取出版描述符、方法细节和结果。使用非随机研究方法学指数和 Cochrane 工具评估文章。完成随机效应荟萃分析。

结果

共纳入 39 项研究。大多数研究是在过去 5 年内发表的（51.3％），是随机对照试验（56.4％）。患者的平均年龄为 27 岁（范围，0.2 至 57 岁），平均样本量为 44 例（范围，12 至 180 例）。荟萃分析显示，与传统器械相比，Piezo 手术术后感觉障碍发生率较低，主要是在下颌手术中（OR，0.29；95％CI，0.11 至 0.77；p = 0.01）和术后第 3 天疼痛（平均差，-0.86；95％CI，-1.20 至-0.53；p <0.01）。手术时间（平均差，8.60；95％CI，-1.27 至 18.47；p = 0.80）或截骨时间（平均差，0.35；95％CI，-2.99 至 3.68；p = 0.84）无统计学差异。根据非随机研究方法学指数工具，大多数研究在临床上是同质的（92％）且质量较高（84％）。根据 Cochrane 工具，少数研究在某些领域存在高偏倚风险（28.6％）。