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全颞下颌关节置换失败的原因:系统评价和荟萃分析。

Reasons for failure of total temporomandibular joint replacement: a systematic review and meta-analysis.

机构信息

Department of Maxillofacial and Facial Plastic Surgery, Lyon Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, Lyon, France.

Department of Maxillofacial and Facial Plastic Surgery, Lyon Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, Lyon, France.

出版信息

Int J Oral Maxillofac Surg. 2022 Aug;51(8):1059-1068. doi: 10.1016/j.ijom.2021.12.012. Epub 2022 Jan 7.

Abstract

The aim of this study was to evaluate the revision rate after total alloplastic temporomandibular joint replacement (TMJR) and determine whether there is a higher risk of revision surgery with stock or custom-fitted prostheses (the two most current TMJR prosthesis types). A systematic review was performed, with a search of PubMed, Google Scholar, and the Cochrane Library in November 2020. Overall, 27 articles were included in this study, describing Biomet and TMJ Concepts prostheses and including postoperative data on complications requiring a return to the operating room. A total of 2247 prostheses were analysed: 1350 stock Biomet prostheses and 897 custom-fitted TMJ Concepts and custom-fitted Biomet prostheses. The global revision rate was 1.19 per 100 prosthesis-years. The most common reason for revision was heterotopic bone formation. Stock prostheses appeared to have a lower risk of revision compared to custom prostheses: rate ratio 0.52 (95% confidence interval 0.33-0.81, P-value 0.003). Regarding causes of revision, the only significant difference between the types of devices was a higher rate of heterotopic bone formation for custom-made prostheses (P = 0.001). The results of this study revealed a low revision rate post TMJR revision, with stock devices even less prone to such risk. Nevertheless, these results can be explained by the fact that custom-made prostheses are more likely to be used for cases in which the anatomy is significantly abnormal or there is a history of multiple joint surgeries, which carry a greater risk of complications and heterotopic bone formation.

摘要

本研究旨在评估全假体颞下颌关节置换(TMJR)后的翻修率,并确定使用库存或定制假体(两种最当前的 TMJR 假体类型)是否存在更高的翻修手术风险。进行了系统评价,于 2020 年 11 月在 PubMed、Google Scholar 和 Cochrane 图书馆进行了搜索。共有 27 篇文章纳入本研究,描述了 Biomet 和 TMJ Concepts 假体,并包括术后需要返回手术室的并发症数据。共分析了 2247 个假体:1350 个库存 Biomet 假体和 897 个定制 TMJ Concepts 和定制 Biomet 假体。总的翻修率为每 100 个假体年 1.19 次。最常见的翻修原因是异位骨形成。库存假体与定制假体相比,翻修风险似乎较低:比率比 0.52(95%置信区间 0.33-0.81,P 值 0.003)。关于翻修原因,两种装置之间唯一的显著差异是定制假体异位骨形成的发生率更高(P = 0.001)。本研究结果显示 TMJR 翻修后翻修率较低,库存假体甚至不太可能出现这种风险。然而,这些结果可以解释为定制假体更可能用于解剖结构明显异常或有多次关节手术史的病例,这些病例并发症和异位骨形成的风险更高。

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