根管治疗中四手操作与传统操作疗效比较的系统评价  

Effectiveness of Four-Handed Dentistry versus Two-Handed Dentistry in Root Canal Therapy:A Systematic Review

作　　者：刘东艳[1] 张玉洁[2] 曾宪涛[1] 韩雪岚[3] 张丽[1] 文素萍[1] 

机构地区：[1]湖北医药学院附属太和医院口腔医学中心,湖北十堰442000 [2]湖北职业技术学院护理学院基础护理教研室,湖北孝感432000 [3]湖北医药学院护理学院,湖北十堰442000

出　　处：《中国循证医学杂志》2012年第6期656-665,共10页Chinese Journal of Evidence-based Medicine

基　　金：湖北医药学院2011年度优秀中青年科技创新团队项目(编号:2011 CZX01)

摘　　要：目的系统评价四手操作与传统操作在根管治疗中的效果。方法计算机检索CBM、VIP、CNKI、WanFang Data、PubMed、EMbase和the Cochrane Controlled Center Register of Controlled Trials(CENTRAL)中相关的中、英文随机对照试验,检索时限均从建库至2011年8月31日。按照Cochrane系统评价方法,由两名评价者对纳入研究进行资料提取和质量评价后,采用RevMan 5.1软件进行Meta分析,并采用GRADEpro le 3.6软件对证据质量进行分级。结果共纳入14个RCT,2 096例患者。定性分析和Meta分析结果显示:与传统操作法相比,四手操作法能显著缩短根管治疗操作时间[治疗总时间:MD=–14.55,95%CI(–20.38,–8.73),P<0.001;治疗平均时间:MD=–9.52,95%CI(–11.50,–7.54),P<0.001;根管预备时间:MD=–11.46,95%CI(–17.73,–5.18),P<0.001;根管消毒时间:MD=–5.22,95%CI(–5.55,–4.89),P<0.001;根管填充时间:MD=–8.16,95%CI(–8.54,–7.78),P<0.001]、提高患者满意度[例数:RR=1.88,95%CI(1.70,2.09),P<0.001;得分:MD=13.6,95%CI(10.86,16.44),P<0.001]和医生满意度[RR=1.84,95%CI(1.30,2.60),P<0.001]、降低窝洞污染的发生[RR=0.27,95%CI(0.08,0.94),P=0.04]和提高根管填充质量[RR=1.39,95%CI(1.26,1.54),P<0.001],其差异均具有统计学意义;但在术后1周疼痛发生上,两者差异无统计学意义[RR=0.48,95%CI(0.21,1.06),P=0.07]。基于GRADE标准,当前结局指标的重要程度分别为"关键"和"重要",证据等级为"极低级"至"高级"。结论现有研究显示,四手操作在根管治疗效果上优于传统操作,临床医护工作者可将其作为弱推荐。但鉴于纳入研究的局限性,故仍需开展大样本、多中心、方法科学和规范的高质量RCT,特别是将"成本-效益分析"作为关键结局指标,以求进一步论证四手操作的效果。Objective To evaluate the effectiveness of four-handed dentistry versus two-handed dentistry in root canal therapy. Methods The CBM, VIP, CNKI, Wanfang, PubMed, EMbase, and CENTRAL were searched for collect- ing relevant randomized controlled trails （RCTs） in English or Chinese from establishment dates to August 31, 2011. After quality evaluation and data extraction independently conducted by two authors, the meta-analyses were performed using the RevMan 5.1, and the evidences were graded using the GRADEprofile 3.6. Results Fourteen studies involving 2 906 patients were included. The results of qualitative analysis and meta-analyses showed that compared with two-handed den- tistry, four-handed dentistry could obviously shorten operating time, improve satisfaction of patients and doctors, lower the risk of hole pollution, and improve treatment quality, all the differences were significant; but there was no significant difference in postoperative pain during the first week. Based on the GRADE system, the importance of outcomes was ＂important＂ or ＂critical＂, while the level of evidences was from ＂extremely low＂ to ＂high＂. Conclusion Current evidence shows that four-handed dentistry is superior to two-handed dentistry, but it suggests a weak recommendation to dental workers. Due to the limitations of included studies, more large-sample and high-quality RCTs, and especially performing ＂cost-effectiveness analysis＂ as the key outcome are required.

关 键 词：根管治疗 四手操作法 传统操作法 系统评价 META分析 随机对照试验 

分 类 号：R781.05[医药卫生—口腔医学]