■已经发表了大量关于眼眶骨折手术时机和入路的实证研究,但是哪种手术时机和方法更好仍然存在争议。我们使用系统综述和荟萃分析来解决这个问题。
■我们在PubMed的数据库中进行了系统的搜索,Cochrane临床试验数据库,Embase,和WebofScience获取相关文献。搜索词包括那些关于或描述眼眶骨折的词,定时,和方法,基于人口,干预,control,结果,和研究(PICOS)框架。采用统计软件包RevMan5.4和Stata14.0进行数据分析。我们试图评估术后并发症,结果以比值比(OR)和95%置信区间(CI)表示。森林地块,敏感性分析,漏斗图,Egger\'stest,并使用纽卡斯尔-渥太华量表(NOS)对纳入的文章进行风险偏倚分析。
■共有7项试验涉及1,283名患者,比较了≤14天与>14天的手术时机,另外14项试验涉及1,768例患者,比较了眼眶骨折经结膜入路(TCA)与睫状下入路(SCA)的手术策略.所有文章质量均高于7分,这意味着所有文章的偏倚风险都很低。在14天内进行的手术显着降低了复视(OR:0.53,95%CI:0.34至0.83,P=0.005)和眼球内陷(OR:0.32,95%CI:0.12至0.83,P=0.02)的发生率;TCA的外翻发生率显着降低(OR:0.20,95%CI:0.10至0.38,P<0.00001),巩膜显示(OR:0.22,95%CI:0.12至0.38,P<0.00001),与SCA相比,可见疤痕(OR:0.15,95%CI:0.03至0.65,P=0.33),但有明显更高的发病率(OR:5.41,95%CI:1.83~15.96,P=0.002).我们纳入的研究中没有明显的发表偏倚。
■≤14天的手术效果优于>14天的手术效果。然而,关于手术方式的选择,TCA和SCA各有优缺点,其中的探索需要进一步的研究。
UNASSIGNED: A large number of empirical studies on the surgical timing and approach of orbital fracture have been published, but which surgical timing and approach is better is still a dispute. We use a systematic
review and meta-analysis to solve this problem.
UNASSIGNED: We performed a systematic search in the databases of PubMed, Cochrane Clinical Trials Database, Embase, and Web of Science for relevant literature. The search terms included those concerning or describing orbital fracture, timing, and approach, which are based on population, intervention, control, outcome, and study (PICOS) framework. The statistical software packages RevMan 5.4 and Stata 14.0 were used for data analysis. We sought to evaluate postoperative complications, and results were expressed as odds ratio (OR) with 95% confidence interval (CI). Forest plots, sensitivity analysis, funnel plots, Egger\'s test, and risk bias analysis were also performed on the included articles by using the Newcastle-Ottawa scale (NOS).
UNASSIGNED: A total of 7 trials involving 1,283 patients compared the surgical timing of ≤14 days versus >14 days, and another 14 trials involving 1,768 patients compared the surgical strategy of transconjunctival approach (TCA) with that of subciliary approach (SCA) for orbital fracture. The quality of all articles was higher than 7 points, which means all articles were at low risk of bias. Surgery conducted within 14 days significantly reduced the incidence of diplopia (OR: 0.53, 95% CI: 0.34 to 0.83, P=0.005) and enophthalmos (OR: 0.32, 95% CI: 0.12 to 0.83, P=0.02); TCA had a significantly lower incidence of ectropion (OR: 0.20, 95% CI: 0.10 to 0.38, P<0.00001), scleral show (OR: 0.22, 95% CI: 0.12 to 0.38, P<0.00001), and visible scar (OR: 0.15, 95% CI: 0.03 to 0.65, P=0.33) compared to SCA, but had a significantly higher incidence of entropion (OR: 5.41, 95% CI: 1.83 to 15.96, P=0.002). There was no significant publication bias among our included studies.
UNASSIGNED: The operation in ≤14 days is better than that in >14 days. However, regarding the choice of surgical approach, TCA and SCA have their advantages and disadvantages, the exploration of which requires further research.