下顎骨骨折の治療を受けている人のQOLに影響を与える要因の分析。システマティックレビューとメタアナリシス

Analysis of factors that influence quality of life of individuals undergoing treatment for mandibular fractures: A systematic review and meta-analysis.

抄録

目的:

下顎骨骨折の治療を受けている人のQoLに影響を与える要因に取り組むこと。

OBJECTIVE: To address the factors that affect the quality of life (QoL) of individuals undergoing treatment for mandibular fractures.

研究デザイン:

このレビューはPreferred Reporting Items for Systematic Reviews and Meta-Analysesのガイドラインに従い、以下のデータベースでPopulations, Interventions, Comparison, Outcomes, and Study Designの原則に従って検索戦略を構築した。PubMed、Web of Science、Scopus、EMBASE で検索した。バイアス評価はRisk Of Bias In Non-randomized Studies of InterventionsとCochrane Risk of Bias tool for randomized trials 2で行った。

STUDY DESIGN: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the search strategy was constructed according to the Populations, Interventions, Comparison, Outcomes, and Study Design principle in the following databases: PubMed, Web of Science, Scopus, and EMBASE. Risk of bias assessment was performed with Risk Of Bias In Non-randomized Studies of Interventions and Cochrane Risk of Bias tool for randomized trials 2.

結果:

19件の研究が含まれた。観察研究15件、臨床試験4件であった。平均年齢は28歳から39歳で、男性の割合が高かった。骨折部位は顆部で、骨折の原因は交通事故であった。治療法は観血的整復術（89.4％）、顎骨固定術（63％）が主体であった。QoL の測定は General Oral Health Assessment Index（31.5％），Oral Health Impact Profile-14（21％） が主であり，かなりばらつきがあった．メタアナリシスでは、open reductionと顎骨固定術はQoLに有意差を認めなかったが（P=.39）、時間の経過とともに有意差が認められた（P < .00001）。その他の要因として、精神的健康、痛み、社交性、外見、摂食障害などがQoLに影響を与えた。

RESULTS: Nineteen studies were included: 15 observational and 4 clinical trials. Mean age ranged from 28 to 39 years, with a higher proportion of males. The condyle was the main fracture location and traffic accident was the fracture cause. Treatment approaches were mostly open reduction (89.4%) and maxillomandibular fixation (63%). QoL measurements varied considerably with the General Oral Health Assessment Index (31.5%) and Oral Health Impact Profile-14 (21%) as the main instruments. Meta-analysis showed that open reduction and maxillomandibular fixation did not present significant differences to QoL (P = .39), but significant differences were observed with time (P < .00001). Other factors affected QoL, such as mental health, pain, socializing, appearance, and eating difficulties.

結論:

このレビューで言及された治療アプローチとは別のいくつかの要因が、下顎骨外傷患者のQoLに影響を及ぼすと思われる。治療法の選択は、十分に確立された臨床基準と、ここで言及した他のすべての要因に基づくべきである。

CONCLUSIONS: Several factors, apart from the treatment approach, mentioned in this review seemed to affect the QoL of patients with mandibular trauma. Treatment choice should be based on well-stablished clinical criteria and on all other factors mentioned here.