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目的:采用Meta分析的方法对比开放复位内固定手术与保守治疗方法在髁突骨折的治疗效果。方法:计算机检索PubMed、Cochrane图书馆、EMbase,收集采用开放内固定技术与采用保守治疗技术治疗髁突骨折的随机对照试验,检索时间均从建库至2012年1月。按照纳入标准由2名研究者独立筛选文献并提取资料,对纳入文献的质量进行评估,采用RevMan5.0软件进行Meta分析。结果:共纳入13个研究,共859例患者,其中手术治疗409例,保守治疗450例。Meta分析结果显示:手术治疗组最大开口度优于保守治疗组[OR=0.35,95%C(I0.21,0.50),P<0.00001],两组差异有统计学意义;随诊1年,手术组错牙合发生率小于保守治疗组,差异有统计学意义[OR=0.29,95%C(I0.13,0.66),P=0.003];随诊1年,手术组与保守治疗组关节疼痛的发生率无统计学差异[OR=0.76,95%C(I0.25,2.29),P=0.63]。两组治疗方法中面部不对称的发生率[OR=1.27,95%C(I0.34,4.79),P=0.73]、下颌活动受限发生率[OR=0.94,95%C(I0.43,2.07),P=0.88]均无显著差异。结论:采用开放手术治疗髁突骨折与采用保守治疗相比在治疗后咬合关系恢复及术后开口度改善方面具有优势。两种治疗方法出现关节区症状的情况无显著差异。对面部发育及下颌功能的影响无明显差异。
Objective: To compare the curative effect of open reduction and internal fixation with conservative treatment in condylar fracture by Meta analysis. METHODS: PubMed, the Cochrane Library, and EMbase were searched by computer. Randomized controlled trials of open internal fixation and conservative treatment of condylar fractures were performed. The search time was from the database to January 2012. According to the inclusion criteria, two researchers independently screened the documents and extracted the data, evaluated the quality of the included documents, and used the software RevMan5.0 for meta-analysis. Results: A total of 13 studies were enrolled, 859 patients were enrolled, of whom 409 were surgically treated and 450 were conservatively treated. The results of Meta analysis showed that the maximal opening of the surgical treatment group was superior to the conservative treatment group [OR = 0.35, 95% C (I0.21, 0.50), P <0.00001], with significant difference between the two groups. The incidence of malocclusion in the operation group was less than that in the conservative treatment group (OR = 0.29, 95% C (I0.13, 0.66), P = 0.003] The incidence of pain was not statistically different [OR = 0.76, 95% C (I0.25, 2.29), P = 0.63]. The incidence of facial asymmetry was significantly higher in both groups (OR = 1.27, 95% C (I0.34, 4.79; P = 0.73) , 2.07), P = 0.88]. CONCLUSIONS: The use of open surgery for the treatment of condylar fractures has advantages over the conservative treatment in terms of restoration of the occlusal relationship and improvement of postoperative opening. There was no significant difference in the appearance of joint symptoms between the two treatments. There was no significant difference in facial development and mandibular function.