国际口腔医学杂志 ›› 2019, Vol. 46 ›› Issue (2): 142-148.doi: 10.7518/gjkq.2019011

• 系统评价 • 上一篇    下一篇

不同翻瓣设计对下颌第三磨牙拔除术后疼痛的影响:系统评价与Meta分析

潘韦霖,曹钰彬,刘畅,刘济远,李春洁,潘剑,华成舸()   

  1. 口腔疾病研究国家重点实验室 国家口腔疾病临床医学研究中心 四川大学华西口腔医院口腔颌面外科 成都 610041
  • 收稿日期:2018-09-17 修回日期:2018-12-03 出版日期:2019-03-01 发布日期:2019-03-15
  • 通讯作者: 华成舸 E-mail:huacg@163.com
  • 作者简介:潘韦霖,硕士,Email: panvelin@163.com
  • 基金资助:
    四川省重点研发项目(2018SZ0181)

Flap design associated pain after the extraction of mandibular third molars: a systematic review and Meta-analysis

Weilin Pan,Yubin Cao,Chang Liu,Jiyuan Liu,Chunjie Li,Jian Pan,Chengge Hua()   

  1. State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2018-09-17 Revised:2018-12-03 Online:2019-03-01 Published:2019-03-15
  • Contact: Chengge Hua E-mail:huacg@163.com
  • Supported by:
    This study was supported by Key Research Project of Sichuan Province(2018SZ0181)

摘要:

目的 评价不同翻瓣设计对下颌第三磨牙拔除术后疼痛的影响。方法 对9个常用数据库进行电子检索,检索时间截至2018年6月29日;并对纳入研究参考文献进行手检。研究质量由2位评价者独立使用Cochrane协作网推荐的标准进行评价并提取数据。应用Review Manager 5.3软件进行Meta分析。结果 共纳入17项RCT研究,纳入受试者合计1 033人,纳入牙数合计1 421颗。17项研究中,1项高偏倚风险,其他16项偏倚风险不确定。封套瓣的术后疼痛轻于标准三角瓣,差异有统计学意义;封套瓣与Szmyd瓣之间差异无统计学意义。结论 Szmyd瓣或封套瓣术后疼痛较标准三角瓣轻,考虑到封套瓣操作的便利性,实际应用中可能优于其他翻瓣设计。

关键词: 第三磨牙, 拔牙, Meta分析, 疼痛, 翻瓣术

Abstract:

Objective This review aimed to assess the effects of flap design on pain after the extraction of mandibular third molars. Methods Nine databases were searched electronically on 29 June 2018. A manual search of reference lists of included studies was conducted. Two reviewers performed quality assessment independently with tools suggested by Cochrane’s handbook, and then, they extracted data. Meta-analysis was performed using Review Manager 5.3. Results Seventeen studies with 1 033 participants and 1 421 teeth were included. Among these studies, one was at high risk of bias, whereas the risk in the other 16 was unclear. The postoperative pain of envelope flap was milder than that of standard triangular flap, and the difference was statistically significant. No significant difference was found in postoperative pain between envelope flap and Szmyd flap. Conclusion Envelope flap and Szmyd flap can be more effective in reducing the postoperative pain of patients than standard triangular flap.

Key words: third molar, tooth extraction, Meta-analysis, pain, surgical flaps

中图分类号: 

  • R782.1

表 1

纳入研究特征表"

研究 方法 纳入人数(牙数) 评估人数(牙数) 干预措施 结局指标VAS
研究类型 地区
Abandansari和Foroughi[6] 口内自身对照RCT 伊朗 20(40) 20(40) 标准封套瓣;标准三角瓣 第2天VAS,没有标准差*
Baqain等[11] 口内自身对照RCT 约旦 20(40) 19(38) 标准封套瓣;Szmyd瓣 第2天VAS
Erdogan等[12] 口内自身对照RCT 土耳其 20(40) 20(40) 标准封套瓣;标准三角瓣 第3天VAS
Goldsmith等[9] 口内自身对照RCT 新西兰 57(114) 42(84) 蒂状瓣;标准封套瓣 第1~4天平均VAS*
何锦泉等[13] 平行对照RCT 中国 400(400) 372(372) 线形瓣;Szmyd瓣 第3天VAS
Kim等[14] 口内自身对照RCT 韩国 30(60) 27(54) Kruger封套瓣;无翻瓣设计 第2天VAS
Kirk等[15] 口内自身对照RCT 新西兰 35(70) 32(64) 标准封套瓣;Szmyd瓣 第2天VAS
Korkmaz等[16] 口内自身对照RCT 土耳其 28(56) 28(56) 标准封套瓣;标准三角瓣 第2天VAS
Koyuncu等[17] 平行对照RCT 土耳其 80(80) 80(80) 标准封套瓣;Szmyd瓣 第2天VAS
Koyuncu等[18] 口内自身对照RCT 土耳其 40(80) 36(72) 刺刀形瓣;Szmyd瓣 第2天VAS
Mobilio等[10] 平行对照RCT 意大利 25(25) 25(25) 标准封套瓣;标准三角瓣 最大VAS*
Nageshwar[7] 平行对照RCT 印度 100(100) 100(100) 逗号形瓣;标准封套瓣 第3天VAS,没有标准差*
乔峰和朱东望[19] 口内自身对照RCT 中国 60(120) 52(104) 标准封套瓣;Szmyd瓣 第2天VAS
Roode和Bütow[8] 口内自身对照RCT 南非 36(72) 33(66) 线形瓣;Szmyd瓣 第2天VAS,没有标准差*
Sandhu等[5] 口内自身对照RCT 印度 20(40) 20(40) 刺刀形瓣;标准封套瓣 VAS的等级资料*
Tareen等[20] 平行对照RCT 巴基斯坦 40(40) 40(40) Kruger封套瓣;标准三角瓣 第2天VAS
Yolcu和Acar[21] 口内自身对照RCT 土耳其 22(44) 22(44) 舌向瓣;Szmyd瓣 第2天VAS

表 2

偏倚风险总结表"

研究 随机方法 分配隐藏 实施盲法 测量盲法 数据完整 报道偏倚 其他偏倚 整体评价
Abandansari和Foroughi[6] 1 1 1 2 2 2 2 1
Baqain等[11] 2 1 1 1 2 2 2 1
Erdogan等[12] 1 1 2 1 2 2 2 1
Goldsmith等[9] 1 1 1 1 0 2 2 0
何锦泉等[13] 1 1 1 1 2 2 2 1
Kim等[14] 2 1 1 2 2 2 2 1
Kirk等[15] 1 1 1 1 2 2 2 1
Korkmaz等[16] 2 1 1 2 2 2 2 1
Koyuncu等[17] 1 1 1 2 2 2 2 1
Koyuncu等[18] 1 1 1 1 2 2 2 1
Mobilio等[10] 1 1 1 1 2 2 2 1
Nageshwar[7] 1 1 1 1 2 2 2 1
乔峰和朱东望[19] 2 1 2 2 1 2 2 1
Roode和Bütow[8] 2 1 1 1 2 2 2 1
Sandhu等[5] 1 1 2 2 2 2 2 1
Tareen等[20] 1 1 1 1 2 2 2 1
Yolcu和Acar[21] 1 1 1 2 2 2 2 1

图 1

封套瓣与其他翻瓣设计的比较===*高位智齿,暴露较多,手术难度较低。"

图 2

Szmyd瓣与非封套瓣设计的比较"

图 3

翻瓣示意图===A:标准三角瓣;B:Szmyd瓣;C:逗号形瓣;D:刺刀形瓣;E:标准封套瓣;F:Kruger封套瓣。"

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