功能矫治器与II类错𬌗畸形气道：伞形综述及三项Meta分析的再分析

文献信息

中文摘要

目的： 功能矫治器对呼吸健康的潜在影响近期受到关注，但证据仍不一致。本伞形综述和Meta分析的主要目的是评估功能矫治器对上气道面积和体积的影响，次要目的是评估文献中任何以患者为中心的报告结局。
方法： 方案已在PROSPERO注册（CRD42024540778）。纳入将患者作为个体、处于青春期前或青春期生长阶段的系统综述和Meta分析。具体而言，选择混合牙列至早期恒牙列、颈椎成熟度（CVM）II-IV期、接受可摘或固定功能矫治器治疗的II类错𬌗畸形生长患者。排除涉及非干预性设计、颅面综合征、主要合并症或已诊断阻塞性睡眠呼吸暂停的研究。遵循PRISMA指南，对MEDLINE、Cochrane、Scopus、Web of Science、LILACS和Ovid进行了全面检索，截至2024年10月。通过OpenGrey筛选灰色文献。使用ROBIS评估偏倚风险。通过校正覆盖面积（CCA）和GROOVE指数评估研究重叠。使用随机效应模型对三项基于CBCT的Meta分析进行定量再分析。
结果： 九篇综述符合纳入标准，其中八篇偏倚风险低，重叠程度为中至高（CCA=10.97%）。功能矫治器显著增加口咽气道体积，尤其是Herbst矫治器（最高达7759 mm3）和Twin Block矫治器（最高达1727 mm3）。Meta回归分析表明，患者年龄每增加一岁，治疗引起的后气道间隙增加平均减少0.36 mm。相反，功能矫治器治疗每增加一个月，上后气道间隙增加0.12 mm，下气道间隙增加0.29 mm。对三项Meta分析的再分析显示，口咽变化具有大的显著效应（标准化均数差[SMD]=1.41；95%置信区间[CI] 0.57-2.26），总气道体积具有中等效应（SMD=0.71；95% CI 0.31-1.11）。没有研究描述任何以患者为中心的报告结局。
结论： 功能矫治器在增加口咽区域体积方面表现出一致的效果。然而，研究间的变异性突出表明需要标准化方案，使用体积评估和足够的随访期，以在多学科方法中确定年轻患者治疗的稳定性。

英文摘要

PURPOSE: The potential influence of functional appliances on respiratory health has recently gained attention, though evidence remains inconsistent. This umbrella review and meta-analysis evaluated the impact of functional appliances on the upper airway area and volume as primary aims, and any patient-centered reported outcomes in the literature as a secondary aim.
METHODS: The protocol was registered in PROSPERO (CRD42024540778). Systematic reviews and meta-analysis including patients as individuals in the prepubertal or circumpubertal growth phases. Specifically, this refers to growing patients in the mixed to early permanent dentition, cervical vertebral maturation (CVM) stages II-IV, with class II malocclusion treated with removable or fixed functional appliances were selected. Studies involving noninterventional designs, craniofacial syndromes, major comorbidities, or diagnosed obstructive sleep apnea were excluded. A comprehensive search was performed across MEDLINE, Cochrane, Scopus, Web of Science, LILACS, and Ovid up to October 2024, following PRISMA guidelines. Grey literature was screened via OpenGrey. Risk of bias was assessed using ROBIS. Study overlap was evaluated through corrected covered area (CCA) and GROOVE indices. Quantitative re-analysis of three CBCT-based meta-analyses was conducted using random effects models.
RESULTS: Nine reviews met the inclusion criteria, eight with low risk of bias and moderate-to-high overlap (CCA = 10.97%). Functional appliances significantly increased oropharyngeal airway volume, especially the Herbst (up to 7759 mm3) and Twin Block (up to 1727 mm3) appliances. Meta-regression analysis indicated that with each additional year of patient age, the treatment-induced increase in posterior airway space decreased by an average of 0.36 mm. Conversely, for each additional month of treatment with the functional appliance, the superoposterior airway space increased by 0.12 mm and the inferior airway space by 0.29 mm. Re-analysis of the three meta-analyses showed a large significant effect for oropharyngeal changes (standardized mean difference [SMD] = 1.41; 95% confidence interval [CI] 0.57-2.26) and a moderate effect for total airway volume (SMD = 0.71; 95% CI 0.31-1.11). No studies described any patient-centered reported outcomes.
CONCLUSION: Functional appliances demonstrated consistent effects in increasing the volume of the oropharyngeal region. However, variability among studies highlights the need for standardized protocols using volumetric assessments and adequate follow-up periods to determine treatment stability in a multidisciplinary approach for young patients.