目的:已经报道了使用术中影像学(IOI)来改善the弓(ZMA)骨折的复位充分性,但是很少有系统的评论研究这个话题。这篇综述的目的是研究和比较IOI与无IOI(N-IOI)的常规方法在ZMA骨折闭合复位中的价值。
方法:MEDLINE的电子检索,Embase,科克伦图书馆,WebofScience,Scopus,并在2022年12月2日之前进行引文检索,以确定使用IOI改善ZMA骨折闭合复位的充分性的对照临床试验.预测变量是使用IOI-是/否(IOIvsN-IOI)。协变量包括成像技术(超声,C型臂,和锥形束计算机断层扫描)和ZMA骨折类型(M形骨折,1方向的机械力;可变断裂,2个方向的机械力)。主要结果变量是与理想镜像位置相比,ZMA骨折的复位充分性(剩余的皮质台阶和脱位角度)。加权或平均差异,风险比率,并计算相应的95%置信区间,其中P>0.05,I2<50%固定效应模型,采用了反之亦然的随机效应模型。
结果:共确定了1250项研究,其中6项研究纳入259名参与者.荟萃分析结果表明,与N-IOI相比,IOI产生的皮质步骤较少(-1.76[-2.42,1.10],P<.00001,固定模型)和位错角(-5.60[-8.08,3.12],P<.00001,固定模型)在可变ZMA骨折患者中,而在M型ZMA骨折中没有检测到显着差异(-0.72,[-2.93,1.48],P=.52;-1.48,[-3.51,0.55],P=.15)。尽管术后矫正没有显着差异(0.35,[0.06,2.01]P=.24,固定模型),所有二次修正病例均发生在N-IOI组.描述性分析表明,IOI具有更好的对称性和外观满意度。
结论:IOI改善了手术的充分性,并导致了更好的术后外观,特别是对于患有可变ZMA骨折的患者。此外,IOI的使用避免了二次手术的风险.在未来的研究中,研究人员应将量表和结果标准化,以促进对减少充分性的直观评估。
The use of intraoperative imaging (IOI) to improve the reduction adequacy of zygomatic arch (ZMA) fractures has been reported, but few systematic reviews have examined this topic. The aim of this review was to investigate and compare the value of IOI with conventional methods without IOI (N-IOI) for the closed reduction of ZMA fractures.
Electronic retrieval of MEDLINE, Embase, Cochrane Library, Web of Science, Scopus, and citation search until December 2, 2022, was used to identify controlled clinical trials that employed IOI for improving adequacy in closed reduction of ZMA fractures. The predictor variable was the use of IOI-yes/no (IOI vs N-IOI). The covariates included imaging technique (ultrasound, C-arm, and cone beam computed tomography) and ZMA fracture type (M-shape fracture, mechanistic force in 1 direction; variable fracture, mechanistic force in 2 directions). The primary outcome variables were the reduction adequacy of ZMA fractures (the remaining cortical step and dislocation angle) compared with the ideal mirrored position. Weighted or mean differences, risk ratios, and corresponding 95% confidence intervals were calculated, where P >.05 and I2<50% fixed effect model was adopted, and a vice versa random effect model was adopted.
A total of 1250 studies were identified, of which 6 studies with 259 participants were included. The meta-analysis results indicated that compared with N-IOI, IOI yielded fewer cortical steps (-1.76 [-2.42, 1.10], P <.00001, fixed model) and dislocation angles (-5.60 [-8.08, 3.12], P<.00001, fixed model) in patients with variable ZMA fractures, while no significant difference was detected in the M-shape ZMA fracture (-0.72, [-2.93, 1.48], P = .52; -1.48, [-3.51, 0.55], P = .15). Although there was no significant difference in postoperative correction (0.35, [0.06, 2.01] P = .24, fixed model), all secondary revision cases occurred in the N-IOI group. Descriptive analysis showed that IOI yielded better symmetry and appearance satisfaction.
IOI improved the adequacy of the procedure and led to a better postoperative appearance, especially for patients with variable ZMA fractures. Furthermore, the use of IOI avoided the risk of secondary surgery. In future studies, researchers should standardize the scale and outcomes to facilitate the intuitive evaluation of reduction adequacy.