Gap arthroplasty versus interpositional arthroplasty for temporomandibular joint ankylosis: a Meta-analysis

doi:10.3969/j.issn.2095-4344.2017.20.017

Abstract

Abstract:

BACKGROUND: Efficacy of gap arthroplasty (GA) versus interpositional arthroplasty (IA) for temporomandibular joint ankylosis (TMJA) is rarely reported, and the treatment efficacy is still under discussion.

OBJECTIVE: To systematically review the efficacy of GA versus IA in the TMJA treatment and patient’s prognosis.

METHODS: A computer-based online research of the databases of WanFang, CqVip, PubMed, Ovid, Embase, Clinical Evidence, Cochrance Library combined with the manual search of relevant controlled trials that compared the resurrence postoperative maximal incision opening and/or recurrence of the two methods for TMJA published before October, 2015 was performed. According to heterogeneity results, the maximal incision opening index was analyzed by random-effect model, and the two groups were subdivided into temporomandibular myofascial flap and other material groups, and then MD and 95%CI were calculated; recurrence was analyzed through fixed effect model, and OR and 95%CI were calculated.

RESULTS AND CONCLUSION: According to the inclusion and exclusion criteria, a total of 18 eligible articles involving 999 patients were enrolled, and the GA and IA were conducted in 656 and 343 cases, respectively. Meta-analysis results of the maximal incision opening were as followings: MD= -1.85, 95%CI: (-3.15, -0.55), Z=2.80, P=0.005, I²=55.4%; the temporomandibular myofascial flap subgroup: MD= -0.94, 95%CI: (-1.84, -0.04), Z=2.05, P=0.040, I²=0.0%; the other material group: MD= -3.36, 95%CI: (-6.66, -0.66), Z=2.39, P=0.017, I²=67.0%. Meta-analysis of the recurrence showed that OR=1.38, 95%CI: (0.87, 2.17), Z=1.37, P=0.170, I²=14.9%. Egger test manifested that there were no publication biases in the literatures. Sensitivity test showed that only one study influenced the total combined Meta-analysis results, and the others were steady. These results indicate that the IA can markedly increases the maximal incision opening in the TMJA treatment compared with the GA, but the two methods have the similar recurrence rate. Due to the limited quantity and quality of the included studies, the above conclusion needs to be verified by more high quality researchs.

Key words: Temporomandibular Joint, Arthroplasty, Recurrence, Meta-Analysis, Tissue Engineering

CLC Number:

R318

Yishakejiang•Maimaiti, Wu Jun, Maimaitituxun•Tuerdi. Gap arthroplasty versus interpositional arthroplasty for temporomandibular joint ankylosis: a Meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2017, 21(20): 3216-3223.

Figures/Tables 3

2.2 纳入研究的基本特征与质量评价纳入研究的基本特征以及质量评分结果均见表1。其中13篇研究应用了颞肌筋膜瓣(temporomandibular myofascial flap，TMF)作为间置物材料。 NOS量表评分结果显示：在病例选择方面，18个研究均基本符合标准，组间可比性与结果评价方面，9个研究均较好。 2.3 Meta分析结果 2.3.1 最大张口度共纳入11个研究[13-15，17-20，23-25，27]，638例患者。随机效应模式Meta分析结果显示，间置物关节成形术组的最大张口度明显比裂隙关节成形术组大，且差异有显著性意义，研究资料有中度异质性[MD=-1.85，95%CI：(-3.15，-0.55)，Z=2.80，P=0.005，I2=55.4%]。以间置材料不同，分颞肌筋膜瓣组和其他材料组进行亚组分析，其分析结果显示间置物关节成形术组的最大张口度明显比裂隙关节成形术组大，且差异有显著性意义，具体值为颞肌筋膜瓣组：[ MD= -0.94，95%CI：(-1.84，-0.04)，Z=2.05，P=0.040，I2=0.0%]；其他材料组：[MD= -3.36，95%CI：(-6.66，-0.66)，Z=2.39，P=0.017，I2=67.0%]，见图2。 2.3.2 复发共纳入14个研究[13-18，20-22，25-26，28-30]，885例患者。固定效应模式Meta分析结果显示，裂隙关节成形术组术后复发率与间置物关节成形术组相当，差异无显著性意义，研究资料不存在异质性，具体值为[OR=1.38，95%CI：(0.87，2.17)，Z=1.37，P=0.170，I2=14.9%]，见图3。 2.4 发表偏倚分析对最大张口度和复发率指标均进行发表偏倚检测，egger检验结果显示：最大张口度组t=0.51， P，复发率组t=1.79，P=0.103，表明最大张口度和复发率指标上，Meta分析结果无明显的发表偏倚，见图4，5。=0.622 2.5 敏感性分析基于最大张口度单个研究的分析结果显示：王俊杰等[27]的研究对Meta分析合并后总异质性检验有明显的影响，如果删除它，合并后的异质性检验结果由I2=55.4%，χ2=22.43，P=0.005变为I2=0.0%，χ2= 5.59，P=0.011，但是对于效应量合并后的结果无显著影响。基于复发率单个研究的分析结果示：Bbatt等[25]的研究对总合并后的异质性检验无影响，但是对总的合并效应量有一定的影响，如果删除它，合并效应量由1.375(0.872，2.167)，P=0.170变为2.357(1.293，4.296)，P=0.005，由差异无显著性意义变为差异有显著性意义。其余研究资料对Meta分析合并效应量结果未见明显影响(图6，7和表2，3)。"

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