上颌骨切除术中手术康复与修复康复的比较分析:关于生活质量评分以及客观语言和咀嚼测量的系统回顾和荟萃分析。

IF 4.3 2区 医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE
János König DMD , Kata Kelemen DMD , Szilárd Váncsa MD , Bence Szabó MSc, PhD , Gábor Varga MSc, PhD , Krisztina Mikulás DMD, PhD , Judit Borbély DMD, PhD , Péter Hegyi MD, PhD , Péter Hermann DMD, MSc, PhD
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引用次数: 0

摘要

问题陈述:无论是外伤、疾病还是先天性畸形导致的口-肛管沟通患者,都可以选择手术重建或假体封堵,但缺乏指导性的跨学科协议。目的:本系统综述和荟萃分析的目的是比较手术重建和假体封堵,确定与基线特征的相关性,从而确定对特定患者最有效的方法:在 4 个数据库中进行了系统检索。搜索、筛选、数据提取和偏倚风险评估由两名审稿人完成。符合条件的研究主要针对因癌症相关上颌骨手术而导致腭颌缺损的患者。外伤性或先天性缺损除外。研究将假体修复(使用手术或确定性闭合器)与使用皮瓣或移植物的手术重建进行了比较。不包括拔牙后进行手术修复的患者。主观和客观结果均用于比较:定性综合分析纳入了 13 篇文章,荟萃分析纳入了 9 篇文章。比较了患者在生活质量问卷、客观言语和咀嚼能力评估中的得分。接受手术重建的患者人数为 206 人,而接受修复钝器的患者人数为 260 人。结果显示两者没有明显差异。不过,在华盛顿大学生活质量问卷的 "活动 "领域,1.92(0.45,3.40)分的差异与临床无关。然而,由于试验的异质性、主观评价的短暂性、参与人数较少以及主要的混杂偏差,无法得出可靠的结论:结论:上颌骨切除术患者人数的不断增加要求在选择哪种康复方式以及何时进行康复方面有确切的证据。结果表明,闭锁器械和手术重建对生活质量和健康结果的影响相似。建议进行多中心登记,根据年龄、辅助疗法、缺损大小和剩余牙列对患者进行分类分析。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparative analysis of surgical and prosthetic rehabilitation in maxillectomy: A systematic review and meta-analysis on quality-of-life scores and objective speech and masticatory measurements

Statement of problem

Patients with oro-antral communication, whether from trauma, disease, or congenital anomalies, have options for surgical reconstruction or prosthetic obturation, but guiding interdisciplinary protocols are lacking.

Purpose

The purpose of this systematic review and meta-analysis was to compare surgical reconstruction and prosthetic obturation, identifying correlations with baseline characteristics to determine the most effective approach for specific patients.

Material and methods

A systematic search was conducted in 4 databases. Searching, screening, data extraction, and risk of bias assessment were performed by 2 reviewers. Eligible studies focused on patients with palatomaxillary defects from cancer-related maxilla surgeries. Traumatic or congenital defects were excluded. The study compared prosthetic restoration (either with surgical or definitive obturators) to surgical reconstruction using flaps or grafts. Patients with surgical restoration after tooth extraction were excluded. Both subjective and objective outcomes were used for comparison.

Results

Thirteen articles were included in the qualitative synthesis and 9 in the meta-analysis. Patient scores on quality-of-life questionnaires, objective speech, and masticatory ability evaluations were compared. The number of patients who underwent surgical reconstruction was 206, whereas 260 patients received prosthetic obturators. Results showed no significant differences. In the “activity” domain of the University of Washington QoL questionnaire, however, the 1.92 (0.45, 3.40) score difference was not clinically relevant. However, the heterogeneity of trials, the transient nature of subjective evaluations, the low number of participants, and major confounding biases did not allow a solid conclusion to be drawn.

Conclusions

The growing number of maxillectomy patients demands firm evidence on which rehabilitation to choose and when it should be done. The result suggests that obturator devices and surgical reconstruction have similar effects on quality of life and health outcomes. A multicentric registry in which patient strata could be analyzed separately by age, adjuvant therapies, defect sizes, and remaining dentition is advocated.
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来源期刊
Journal of Prosthetic Dentistry
Journal of Prosthetic Dentistry 医学-牙科与口腔外科
CiteScore
7.00
自引率
13.00%
发文量
599
审稿时长
69 days
期刊介绍: The Journal of Prosthetic Dentistry is the leading professional journal devoted exclusively to prosthetic and restorative dentistry. The Journal is the official publication for 24 leading U.S. international prosthodontic organizations. The monthly publication features timely, original peer-reviewed articles on the newest techniques, dental materials, and research findings. The Journal serves prosthodontists and dentists in advanced practice, and features color photos that illustrate many step-by-step procedures. The Journal of Prosthetic Dentistry is included in Index Medicus and CINAHL.
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