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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, there are not many literatures about the study of the treatment of temporomandibular joint ankylosis between arthroplasty and arthroplasty at home and abroad. The conclusions are different and the efficacy is controversial. Objective: To systematically evaluate the curative effect of interbody fusion and joint reconstruction in patients with temporomandibular joint ankylosis. Methods: The databases of VIP Chinese Science and Technology Periodical Database, Wanfang Database, PubMed, Ovid, Embase, Clinical Evidence and Cochrance Library were retrieved by computer and searched by hand. To collect the clinical control study of arthroplasty and arthrodesis of temporomandibular joint published before December 2015 at home and abroad. According to inclusion criteria and exclusion criteria, screening and quality evaluation of the literature. Stata13.1 software was used to perform Meta-analysis on maximum mouth opening and recurrence rate. RESULTS AND CONCLUSION: (1) 15 articles were included in the study. (2) Maximum mouth opening index: The total combined results were MD = 0.99,95% CI: 1.43,3.40, Z = 0.80, P = 0.424, 73.9%. The subgroup analysis showed that the temporal muscle fascia flap group and rib costal cartilage transplantation group: MD = 0.84,95% CI: (-1.94, 3.63), Z = 0.59, P = 0.553, I2 = 82.2 %; Other materials group: MD = 2.08, 95% CI: (-3.03, 7.19), Z = 0.80, P = 0.426, I2 = 0.0% (0.59,2.15), Z = 0.36, P = 0.721, I2 = 0.0%. (4) The Egger test and Begg test results showed that there was no publication bias. (5) The results of sensitivity test showed that the included studies (6) The results of the analysis indicated that the application of spacer arthrodesis and joint reconstruction in the treatment of patients with temporomandibular joint ankylosis has the same effect on maximal mouth opening and recurrence rate after repair. Limited by the number and quality of studies involved, more conclusions need to be drawn from more high-quality studies.