间置物关节成形与关节重建修复颞下颌关节强直效果功能的Meta分析  

Efficacy of interpositional arthroplasty versus reconstruction arthroplasty for temporomandibular joint ankylosis: a Meta-analysis

作　　者：依沙克江.买买提 吴俊 买买提吐逊.吐尔地 Yishakejiang Maimaiti Wu Jun Maimaitituxun Tuerdi(Department of Alveolar Surgery, U rumqi Stomatology Hospital, Urumqi 830002, Xinjiang Uyghur Autonomous Region, China Department of Maxillofacial Trauma and Orthognathic Surgery, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Urumq Autonomous Region, China)

机构地区：[1]乌鲁木齐市口腔医院齿槽外科,新疆维吾尔自治区乌鲁木齐市830002 [2]新疆医科大学第一附属医院颌面创伤正颌外科,新疆维吾尔自治区乌鲁木齐市830054

出　　处：《中国组织工程研究》2017年第4期650-656,共7页Chinese Journal of Tissue Engineering Research

基　　金：新疆医学动物模型研究重点实验室开放课题项目(XJDX1103-2013-05)~~

摘　　要：背景:目前,国内外关于研究间置物关节成形术与关节重建术治疗颞下颌关节强直的文献不多,结论各异,疗效存在争议。目的:系统评价颞下颌关节强直患者行间置物关节成形与关节重建的疗效。方法:计算机检索维普中文科技期刊数据库、万方数据库、PubMed、Ovid、Embase、Clinical Evidence、Cochrance图书馆等,并且结合手工检索。收集2015年12月以前国内外公开发表的间置物关节成形术与关节重建术治疗颞下颌关节强直疗效的临床对照研究。按照纳入标准和排除标准进行筛选文献并对其进行质量评价。运用Stata13.1软件对最大张口度和复发率进行Meta分析。结果与结论:(1)纳入文献:15篇;(2)最大张口度指标:总合并结果为MD=0.99,95%CI:(-1.43,3.40),Z=0.80,P=0.424,I2=73.9%;对其亚组分析结果显示,颞肌筋膜瓣组与肋骨肋软骨移植组:MD=0.84,95%CI:(-1.94,3.63),Z=0.59,P=0.553,I2=82.2%;其他材料组:MD=2.08,95%CI:(-3.03,7.19),Z=0.80,P=0.426,I2=0.0%;(3)复发率指标结果:为OR=1.13,95%CI:(0.59,2.15),Z=0.36,P=0.721,I2=0.0%;(4)Egger检验和Begg检验结果:均显示不存在发表偏倚;(5)敏感度检验结果显示:所纳入的研究对Meta分析合并效应量无明显影响,Meta分析结果稳健;(6)分析结果提示:应用间置物关节成形与关节重建治疗颞下颌关节强直患者,修复后最大张口度和复发率方面效果等同。受纳入研究数量和质量所限,所得结论尚需开展更多高质量研究予以验证。BACKGROUND： At present, studies on interpositional arthroplasty versus reconstruction arthroplasty for temporomandibular joint ankylosis remain scarce and controversial.OBJECTIVE： To systematically review the efficacy of interpositional arthroplasty versus reconstruction arthroplasty in the treatment of temporomandibular joint ankylosis. METHODS： A computer-based online search was conducted in VIP, Wangfang, Pub Med, Ovid, Embase, Clinical Evidence, Cochrance Library databases before December 2015 to compare the efficacy of interpositional arthroplasty versus reconstruction arthroplasty for temporomandibular joint ankylosis. Meta-analysis of maximal incisal opening and recurrence rate were performed using Stata13.1 software by extracting data from the relevant articles. RESULTS AND CONCLUSION： A total of 15 studies were included. Meta-analysis results of maximal incisal opening： the total combined result was MD=0.99,95%CI（-1.43, 3.40）, Z=0.80, P=0.424, I2=73.9%, and the analysis results from temporomandibular myofascial flap group versus costochondral graft group showed that MD=0.84, 95%CI（-1.94, 3.63）, Z=0.59, P=0.553, I2=82.2%; from the other material group MD=2.08, 95%CI（-3.03, 7.19）, Z=0.80, P=0.426, I2=0.0%. The recurrence rate： OR=1.13, 95%CI（0.59, 2.15）, Z=0.36, P=0.721, I2=0.0%. Egger test and Begg test showed that there were no publication biases in the literatures. The sensitivity test showed that the meta-analysis results were steady because no study influenced the total combined result in the Meta-analysis. These results indicate that interpositional arthroplasty exhibited similar efficacy as reconstruction arthroplasty in the treatment of temporomandibular joint ankylosis. This study was limited by a lack of high-quality studies.

关 键 词：颞下颌关节 关节强直 关节成形术 软骨 移植 组织工程 组织构建 骨组织工程 颞下颌关节强直 间置物关节成形术 关节重建术 颞肌筋膜瓣 肋骨肋软骨移植 最大张口度 复发 META分析 

分 类 号：R318[医药卫生—生物医学工程]