放射治疗后颌骨种植体存留影响因素的Meta分析

发布时间：2018-08-18 17:42

【摘要】：目的：对颌面部肿瘤放射治疗后颌骨种植体存留的影响因素,包括种植间隔时间、颌骨位置、放疗剂量、高压氧治疗进行Meta分析，评估种植体存留的关联因素，为临床制定治疗方案提供参考依据。方法：通过计算机检索1980年1月-2013年6月Cochrane图书馆临床随机对照实验库、医学文献分析和检索系统、荷兰医学文摘和中国知网数据库、维普数据库、中国生物医学文献数据库,全面收集有关颌骨放射治疗后种植体存留率/失败率影响因素的相关文献。检索语种为中文和英文。按照Cochrane系统评价方法，采用种植体失败率作为指标评价种植间隔时间、种植颌骨位置、放疗剂量、高压氧治疗等影响因素的作用，应用Revman5.2软件，根据文献异质性检验结果，采用固定效应模型或随机效应模型进行Meta分析，对结果进行敏感性分析，利用漏斗图分析各个研究间的发表性偏倚。结果：根据文献纳入与排除标准，纳入文献12篇，其中文献证据级别为Ib1篇，IIb11篇；证据强度低等4篇，中等8篇。Meta分析结果显示：与放疗后种植体失败率有显著统计学差异的影响因素为：颌骨位置与放疗剂量，其合并效应量分别为（OR颌骨=12.69，95%CI：4.74-7.56，P0.00001，I2=61%）（OR剂量=0.39、95%CI：0.25-0.62、P0.0001，I2=0%）。种植间隔时间、高压氧治疗与放疗后种植体失败率间无统计学差异，合并效应量为（OR时间=1.27,95%CI:0.95-1.70， P=0.10，I2=22%）、OR高压氧=1.62（95%CI：0.29-9.0，P=0.58，I2=89%）。对不同影响因素进行敏感性分析的结果显示，，高压氧治疗影响因素结果差异较大，显示该结果可靠性存疑，其余分析结果与原结果相似，认为Ｍeta分析结果稳定可靠。结论： 1、在颌面部肿瘤患者放射治疗后植入种植体，下颌骨比上颌骨、放疗剂量小于50Gy比大于50Gy种植存留率更高,有显著统计学差异。 2、种植时间间隔6-12个月与大于12个月的种植存留率差异间无明显统计学意义。 3、尚不能确定高压氧治疗能提高放射治疗后颌骨种植体的存留率。 4、Meta分析结果受原始资料影响，应展开更多的高质量多中心的随机临床试验，以指导临床实践。
[Abstract]:Objective: to evaluate the relative factors of implant retention in patients with maxillofacial neoplasms after radiotherapy by Meta analysis, including implant interval, maxillary location, radiotherapy dose and hyperbaric oxygen therapy. To provide a reference for clinical treatment. Methods: the clinical randomized controlled experiment database, medical literature analysis and retrieval system, Dutch medical abstract and Chinese knowledge network database, Weip database and Chinese biomedical literature database were searched by computer in Cochrane library from January 1980 to June 2013. A comprehensive collection of relevant literature on the impact of implant survival rate / failure rate after jaw radiotherapy. The search languages are Chinese and English. According to the evaluation method of Cochrane system, the implant failure rate was used as an index to evaluate the effects of implant interval, implant location, radiotherapy dose, hyperbaric oxygen therapy and so on. Revman5.2 software was used according to the results of literature heterogeneity test. The fixed effect model or random effect model was used to analyze the Meta, the sensitivity of the results was analyzed, and the published bias was analyzed by funnel graph. Results: according to the criteria of literature inclusion and exclusion, 12 articles were included, of which 11 were classified as Ib1, and 4 were of low evidence intensity. The results of Meta-analysis showed that there were significant differences in the failure rate of implants between the two groups: the jaw position and the dose of radiotherapy, the combined effect was 12.69% CI: 4.74-7.56% P0.00001P0.00001%) (OR dose of 0.3995 CIW 0.25-0.62P0.000 I 2o 0%). There was no significant difference in the failure rate of implants between hyperbaric oxygen therapy and radiotherapy. The combined effect was (OR time 1.2795 CI: 0.95-1.70, P0. 10% I222%) or hyperbaric oxygen 1.62 (95 CI: 0.29-9.0% P0.58I289%). The results of sensitivity analysis of different influencing factors showed that the results of hyperbaric oxygen therapy were quite different, indicating that the reliability of the results was doubtful, and the other results were similar to the original ones. The results of Meta analysis were considered to be stable and reliable. Conclusion: 1. After radiotherapy in patients with maxillofacial neoplasms, implants were implanted, mandibular bone was higher than maxillary bone, and radiotherapy dose less than 50Gy was higher than 50Gy implantation, the survival rate of implants was higher than that of maxillofacial tumors. There was significant statistical difference. 2. There was no significant difference in implant survival rate between 6-12 months and more than 12 months. 3. It is not certain that hyperbaric oxygen therapy can improve the survival rate after radiotherapy The survival rate of mandibular implants. 4. The results of meta-analysis were affected by the original data. More high-quality multi-center randomized trials should be conducted to guide clinical practice.
【学位授予单位】：暨南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R739.8

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