上颌快速扩弓联合前方牵引后骨性Ⅲ类伴上颌骨发育不足患者上气道变化的meta分析

目的 系统评价上颌快速扩弓联合前方牵引后骨性Ⅲ类伴上颌骨发育不足患者上气道的变化情况。方法 计算机检索 PubMed、Cochrane Library、Embase、CNKI、CBM、维普及万方数据库等中英文数据库中所有关于上颌快速扩弓联合前方牵引后骨性Ⅲ类伴上颌骨发育不足患者上气道变化方面的文献,检索时限均为建库至 2018年 3 月1日。由 2 名研究者根据纳入与排除标准筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3 软件进行 meta 分析。结果 最后纳入 12 篇文献,Meta 分析结果显示,上颌快速扩弓联合前方牵引后,鼻咽容积MD=0.89 cm³,95%CI(0.36 cm³,1.42 cm³),P=0.001]显著大于治疗前,口咽容积MD=0.44 cm³,95%CI(-0.01 cm³,0.89 cm³),P=0.05]、喉咽容积MD=0.37 cm³,95%CI（-1.31 cm³,1.76 cm³）,P=0.61]较治疗前差异无统计学意义。上气道上部变化PNS-ad1MD=2.11 mm,95%CI（1.87 mm,3.94 mm）,P<0.00001]、 PNS-ad2MD=2.91mm,95%CI(1.87 mm,3.94 mm),P<0.00001]显著大于治疗前,上气道下部MPSMD=0.47 mm,95%CI(-0.89 mm,1.87 mm),P=0.5]、IPSMD=0.42 mm,95%CI(-0.90 mm,1.75 mm,P=0.53)]较治疗前差异无统计学意义。结论 上颌快速扩弓联合前方牵引可以增加安氏Ⅲ类伴上颌骨发育不足患者鼻咽部容积及矢状径,可通过扩大气道间隙,降低上颌骨发育不足患者发生阻塞性睡眠呼吸暂停综合征的风险。

Upper airway changes in patients with skeletal Class Ⅲ maxillary retrognathia after rapid maxillary expansion and protraction: a meta-analysis

PURPOSE: This study was to evaluate the upper airway changes in patients with skeletal Class Ⅲ maxillary retrognathia after rapid maxillary expansion and protraction. METHODS: An electronic search in PubMed, Cochrane Library, Embase, CNKI, CBM, VIP and Wanfang was performed until March 1st, 2018. According to the inclusion and exclusion criteria, two investigators respectively reviewed the literature and selected eligible studies, then assessed the risks of bias and extracted the data of the included studies. The extracted data were quantitatively analyzed with Revman 5.3 software. RESULTS: A total of 12 studies were included for meta-analysis. The results showed that, after treatment the nasopharyngeal volum(P<0.05) increased significantly. However, no statistically significant differences in oropharyngeal volume(P>0.05) and hypopharyneal volume (P>0.05) existed. The nasopharyngeal airway dimensions had increased significantly with the following measurements: PNS-ad1 (P<0.05), PNS-ad2(P<0.05). However, no statistically significant differences in lower pharynx dimension existed with the following measurements: MPS(P>0.05), IPS(P>0.05). CONCLUSIONS: Rapid maxillary expansion and protraction can increase nasopharyngeal volume and sagittal airway dimensions in skeletal Class Ⅲ subjects with maxillary retrusion. It may be suggested that rapid maxillary expansion and protraction have the potential to reduce the risk of obstructive sleep apnea syndrome in children with maxillary retrusion by enlarging airway space.