腮腺前缘咬肌入路与穿腮腺入路手术治疗髁突骨折患者术后并发症的对比

doi:10.12439/kqhm.1005-4979.2024.02.007

摘要/Abstract

摘要：

目的： 研究腮腺前缘咬肌入路（retromandibular transmasseteric anterior parotid approach，RMTMAP）与传统穿腮腺手术入路（retromandibular transparotid approach，RMTP）对髁突骨折患者术后面神经损伤及涎瘘发生率的影响。方法： 对各大中英文数据库[PubMed、Embase、Cochrane图书馆、中国知网数据库(CNKI)、中国生物医学文献数据库(CBM）、维普、万方及中国临床试验注册中心]关于髁状突骨折的手术治疗入路的随机对照试验进行全面的文献检索，检索时限为建库至2021年11月，并进行手动检索以避免遗漏。共纳入7篇临床随机对照试验，纳入研究的文献质量为中至高等，采用RevMan 5.3软件进行meta分析。结果： 共有7篇文献纳入本研究，结果显示2组患者术后均能达到满意的效果，RMTMAP组较RMTP组的术后面神经损伤发生率更低[相对危险度（relative risk，RR）=0.49，95%CI=0.25~0.97，P=0.04]，RMTMAP组术后涎瘘发生率较低（RR=0.35，95%CI=0.15~0.85，P=0.02），2组差异具有统计学意义。结论： RMTMAP组术后面神经损伤及涎瘘的发生率均小于RMTP组，且能够取得较为满意的临床效果，值得临床推广使用。

关键词: 髁突骨折, 腮腺前缘手术入路, 穿腮腺手术入路, meta分析

Abstract:

Objective: To compare the influence between retromandibular transmasseteric anterior parotid approach (RMTMAP) and retromandibular transparotid approach (RMTP) on the facial nerve damage and salivary fistula in the treatment of condylar fractures. Methods: A comprehensive literature search of randomized controlled trials on surgical approaches for condylar fractures was undertaken in various Chinese and English databases (the Cochrane Library, PubMed, Embase, CNKI, CBM, VIP, Wanfang and Chinese Clinical Trial Registry). The search period is from the establishment of the database until now (November 2021), and manual search is carried out to avoid omissions. A total of 7 studies restricted in randomized controlled trials were included, and the quality of these studies was moderate to high. RevMan 5.3 software was used to perform meta analysis. Results: A total of 7 studies were included in this study, and the results showed that patients in both groups could achieve satisfactory results after surgery. The incidence of postoperative facial nerve injury in RMTMAP group was lower than that in RMTP group [relative risk (RR)=0.49, 95%CI=0.25-0.97]. P=0.04], and the incidence of postoperative salivary fistula was lower in the RMTMAP group (RR=0.35, 95%CI=0.15-0.85, P=0.02). The difference between the two groups was statistically significant. Conclusion: A lower incidence of postoperative facial nerve injury and salivary fistula was observed in RMTMAP group than that in RMTP group. Therefore, RMTMAP deserves clinical application.

Key words: condylar fractures, retromandibular transmasseteric anterior parotid approach, retromandibular transparotid approach, meta analysis

程维, 肖祎婷, 李雅冬. 腮腺前缘咬肌入路与穿腮腺入路手术治疗髁突骨折患者术后并发症的对比[J]. 《口腔颌面外科杂志》, 2024, 34(2): 122-128.

CHENG Wei, XIAO Yiting, LI Yadong. Comparison of postoperative complications between retromandibular transmasseteric anterior parotid approach versus retromandibular transparotid approach for the treatment of condylar fractures[J]. 《Journal of Oral and Maxillofacial Surgery》, 2024, 34(2): 122-128.

https://journal06.magtech.org.cn/Jweb_joms/CN/Y2024/V34/I2/122

图/表 6

参考文献 34

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文献作者	年份	性别男∶女	样本量(RMTMAP/RMTP)	年龄/岁	术后评估结局指标	创伤原因	随访时间/月	手术入路
Mandal ^[12]	2021	65∶10	75(37/38)	26.3±6.3	手术时长、出血量、面神经功能、涎瘘、手术部位感染率、瘢痕	交通事故、殴打、高空坠落、运动损伤	3	下颌后穿腮腺前沿咬肌入路；下颌后穿腮腺入路
Parihar ^[13]	2019	28∶2	30(15/15)	33.7	涎瘘、弗雷综合征、手术时长、开口度、最大侧向收缩运动、咬合关系	交通事故	6	下颌后穿腮腺入路；下颌后穿腮腺前沿咬肌入路
Ramaraj ^[14]	2020	未提及	30(15/15)	16~62(37)	手术时长、骨暴露量、术中出血量、术后感染、涎瘘、面神经损伤	未提及	6	下颌后穿腮腺入路；下颌后穿腮腺前沿咬肌入路
Hou ^[15]	2014	未提及	60(30/30)	32.5	出血量、错颌畸形、感染、开口度、面神经损伤、瘢痕、手术时间、涎瘘	未提及	12	穿腮腺入路；下颌后穿腮腺前入路
苏荣斌^[16]	2021	29∶17	46(23/23)	24~53(38.2±4.6)	前伸运动、侧方运动、开口度、面神经损伤、关节不适、咬合紊乱、涎瘘、满意度	交通事故、意外跌倒	未提及	穿腮腺前沿咬肌入路；穿腮腺入路
辛江波^[17]	2015	55∶9	64(32/32)	19~53(27)	手术时长、开口度、咬合关系、面神经损伤、涎瘘	未提及	36	腮腺前缘入路；横断腮腺入路
杨双林^[18]	2019	34∶18	52(26/26)	15~51	手术时长、开口度、咬合关系、面神经损伤、涎瘘	未提及	12	经颌后腮腺前缘入路；颌后切口穿腮腺入路

文献作者	年份	性别男∶女	样本量(RMTMAP/RMTP)	年龄/岁	术后评估结局指标	创伤原因	随访时间/月	手术入路
Mandal ^[12]	2021	65∶10	75(37/38)	26.3±6.3	手术时长、出血量、面神经功能、涎瘘、手术部位感染率、瘢痕	交通事故、殴打、高空坠落、运动损伤	3	下颌后穿腮腺前沿咬肌入路；下颌后穿腮腺入路
Parihar ^[13]	2019	28∶2	30(15/15)	33.7	涎瘘、弗雷综合征、手术时长、开口度、最大侧向收缩运动、咬合关系	交通事故	6	下颌后穿腮腺入路；下颌后穿腮腺前沿咬肌入路
Ramaraj ^[14]	2020	未提及	30(15/15)	16~62(37)	手术时长、骨暴露量、术中出血量、术后感染、涎瘘、面神经损伤	未提及	6	下颌后穿腮腺入路；下颌后穿腮腺前沿咬肌入路
Hou ^[15]	2014	未提及	60(30/30)	32.5	出血量、错颌畸形、感染、开口度、面神经损伤、瘢痕、手术时间、涎瘘	未提及	12	穿腮腺入路；下颌后穿腮腺前入路
苏荣斌^[16]	2021	29∶17	46(23/23)	24~53(38.2±4.6)	前伸运动、侧方运动、开口度、面神经损伤、关节不适、咬合紊乱、涎瘘、满意度	交通事故、意外跌倒	未提及	穿腮腺前沿咬肌入路；穿腮腺入路
辛江波^[17]	2015	55∶9	64(32/32)	19~53(27)	手术时长、开口度、咬合关系、面神经损伤、涎瘘	未提及	36	腮腺前缘入路；横断腮腺入路
杨双林^[18]	2019	34∶18	52(26/26)	15~51	手术时长、开口度、咬合关系、面神经损伤、涎瘘	未提及	12	经颌后腮腺前缘入路；颌后切口穿腮腺入路

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