脱细胞真皮基质预防下颌阻生磨牙拔除术后并发症效果的Meta分析  

Effectiveness of Acellular Dermal Matrix Prophylaxis in Mandibular Impacted Molars Extraction:A Meta-analysis

作　　者：解龙川[1,2] 徐晓明[1] 曾宪涛[1] 

机构地区：[1]湖北医药学院附属太和医院口腔科,湖北十堰442000 [2]湖北医药学院附属太和医院门诊部,湖北十堰442000

出　　处：《湖北医药学院学报》2012年第6期458-463,共6页Journal of Hubei University of Medicine

基　　金：湖北省教育科学"十二五"规划2012年度重点课题(2012A049);湖北医药学院2011年度优秀中青年科技创新团队项目(2011CZX01)

摘　　要：目的:采用Meta分析的方法综合评价脱细胞真皮基质(ADM)预防下颌阻生磨牙拔除术后并发症的效果。方法:计算机检索PubMed、CENTRAL、SinoMed、CNKI、VIP和万方数据库中1999年至2012年7月发表的相关研究,并辅以手检。对符合纳入标准的研究进行质量评价和资料提取后,采用Meta-Analyst 3.13软件进行Meta分析,并遵照GRADE系统采用GRADEpro 3.6软件进行证据等级评定。结果:共纳入12个(半)随机临床对照试验,共1267例使用ADM的患者。Meta分析结果表明,与空白对照相比,脱细胞真皮基质可以显著降低86%发生干槽症的风险(RR=0.14,95%CI=0.09～0.24,P<0.001)、66%发生术后出血的风险(RR=0.34,95%CI=0.20～0.60,P<0.001)、42%发生肿胀的风险(RR=0.58,95%CI=0.35～0.96,P=0.04)及38%张口受限的发生风险(RR=0.72,95%CI=0.52～0.99,P=0.04);GRADE证据等级依次为高级、中级、极低级和低级。结论:基于当前证据,脱细胞真皮基质预防下颌阻生磨牙拔除术后并发症的效果是积极的。但建议在将其作为常规推荐之前,严格按照CONSORT声明开展大样本、高质量、将"成本-效益分析"作为必备结局指标的随机对照盲法研究进一步论证。Objective To evaluate the efficacy of acellular dermal matrix(ADM) prophylaxis in mandibular impacted molars(IM) extraction by performing a meta-analysis.Methods The PubMed,CENTRAL,SinoMed,CNKI,VIP,and Wanfang databases were searched from 1999 to July 2012,in order to retrieve relevant studies.Manual searching was also performed.After assessing the methodological quality and data extraction,a meta-analysis was conducted by using the Meta-Analyst 3.13 software;and the levels of evidences were assessed according to GRADE system by using GRADEpro 3.6 software.Results Twelve RCTs and CCTs involing 1 267 teeth(ADM group) were included.The meta-analysis showed that compared with blank control group,the ADM could obviously decrease the rate of dry socket(RR=0.14,95%CI=0.09~0.24,P<0.001),rebleeding(RR=0.34,95%CI=0.20~0.60,P<0.001),swelling(RR=0.58,95%CI=0.35~0.96,P=0.04),and trismus(RR=0.72,95%CI=0.52~0.99,P=0.04);in sequence,the levels of evidences were high,morderate,very low,and low.Conclusions Based on current evidences,ADM can effectively reduce the complications after mandibular IM extraction.However,large sample,randomised,controlled,as an index of 'cost-benefit analysis',and according to CONSORT statement trails are suggested,before recommending ADM as a routine protocol.

关 键 词：阻生磨牙 下颌 拔除 脱细胞真皮基质 META分析 GRADE系统 

分 类 号：R782.051[医药卫生—口腔医学]