正畸正颌联合矫治骨性 III 类错牙合软硬组织稳定性的 Meta 分析

摘要

目的：采用 Meta 分析方法评价正畸正颌联合矫治骨性 III 类错�软硬组织的稳定性。方法：计算机检索 Cochrane Library、PubMed、Medline、CNKI、万方等中外文数据库中符合要求的随机对照试验、半随机对照试验、临床病例对照试验的文献，检索日期截止2013-12-31。按照纳入、排除标准，由2名经过系统评价专业培训的研究者对纳入文献进行严格的质量评价，提取中、高等质量文献的数据资料。然后采用 RevMan 5．2软件进行 Meta 分析。结果：最终纳入4篇文献，共178例患者，均为临床病例对照试验（CCT）。Meta 分析结果示：硬组织稳定性：SNA（WMD ＝－0．58，95％CI[－1．18，0．02]）、SNB （WMD ＝0．25，95％CI[－0．42，0．91]）、ANB（WMD ＝－0．70，95％CI[－1．44，0．04]）、MP-SN（WMD ＝0．39，95％CI [－0．25，1．04]），术后与术后3年差异无统计学意义，A 点保持相对稳定位置，B 点较术后有复发；软组织稳定性：术后与术后3年患者的软组织总体上保持稳定，仅下唇突度术后3年有所增大，显示其有一定的复发。结论：骨性 III 类错�患者经正畸联合双颌手术治疗后，软硬组织基本保持了长期的稳定性，仅下颌有一定的向前复发，下唇突度有所增大。%Objective:To analyze the long term stability of the hard and soft tissues of the skeletal class III malocclusion after ortho-dontic-surgery by Meta-analysis.Methods:The randomized controlled trials(RCT),quasi-randomized controlled trials and clinical case-control trials(CCT)about the long-term stability of skeletal class III malocclusion after orthodontic-surgery was collected from Co-chrane Library,PubMed,Medline,CNKI,VIP and Wanfang databases from inception to December 31,2013 by literature search.Two professionally trained reviewers evaluated the quality of the screened literatures,scored literatures with the NOS evaluation tool,and collectd data and information of the literatures with medium and higher quality.Revman5.2 was used for the Meta-analysis.Results:4 CCTs articles and 178 cases were included.The results of Meta-analysis showed that:1.The stability of the hard tissue:the differ-ence of SNA(WMD =-0.58,95%CI[-1.18,0.02]),SNB (WMD =0.25,95%CI[-0.42,0.91]),ANB(WMD =-0.70, 95%CI[-1.44,0.04])and MP-SN(WMD =0.39,95%CI[-0.25,1.04])at post-operation and 3 years after operation had no statistical significance.Point A remained relatively stable position and point B had some replace 3 years after surgery compared with that at post-operative.2.The stability analysis of soft tissue:the healing effect of the soft tissue was stable,except the LowerlipeNperp had some recurrence 3 years after surgery.Conclusion:In the long term,after orthodontic and surgical treatment for skeletal class III malocclusion the hard and soft tissues kept stabile except a little replapse of the mandibular and the LowerlipeNperp.