A Network Meta-analysis Of The Effects Of Different Methods On Temporomandibular Joint Ankylosis

Objective:The purpose of this study aims to use network meta-analysis,system evaluation of TMJA patients between gap arthroplasty(GA),interpositional gap arthroplasty(IGA),reconstructionarthroplasty(RA),as well as with distraction osteogenesis(DO)the clinical curative effect,To provide evidence-based medical evidence for the clinical treatment of temporomandibular joint ankylosis(TMJA).Methods: Adopt the method of key words and free words,search domestic and foreign databases on the computer,including Pubmed,Embase,Cochrane Library,Web of Science,CBM,CNKI,VIP and Wangfang Database,combined with manual retrieval,collect each database to build up to November 2019,published at home and abroad on fracture arthroplasty,interposition arthroplasty,joint reconstruction and distraction Relevant research on the clinical effect of osteogenic joint reconstruction in the treatment of temporomandibular joint ankylosis.The included articles were screened according to the established document inclusion and exclusion criteria;the Newcastle-Ottawa Scale(NOS)was used to evaluate the document quality according to the type of study.The net meta-analysis of the efficacy of different surgical methods for the treatment of temporomandibular joint ankylosis using stata14.0 software and the gemtc package in R language was performed,and direct and indirect comparative analyses were performed according to the differences in the comparative study of interventions.Finally,sensitivity analysis and publication bias analysis were performed on the analysis results.Results:A total of 30 articles were included,including 8 non-randomized controlled trials and 22 retrospective studies.1648 cases were included,including 645 cases in the fracture arthroplasty group,313 cases in the interposition arthroplasty(autologous tissue implantation)group,76 cases in the interposition arthroplasty(allogous tissue implantation)group,and joint reconstruction(autologous bone Tissue reconstruction)group of 374 cases,joint reconstruction(allogous tissue reconstruction)group of 218 cases,stretch osteogenesis reconstruction group of 22 cases.Potential scale reduction parameters(PSRF)of the openness and recurrence rate were close to 1,indicating good convergence;the non-consistency test under the Node-splitting model was not statistically significant(P>0.05).Meta analysis results show that the degree of mouth opening: RA Allo(Artificial joint transplantation reconstructionarthroplasty)is the best,superior to GA(Gap arthroplasty)and IGAAllo(allogous tissue transplantation interpositional gap arthroplasty);GA Compared with RAAllo,WMD =-5.44,95% CI [-9.14,-1.42];Compared with RAAllo,IGAAllo has WMD =-4.01,95% CI [-6.83,-1.59].Comparison of recurrence rates: DO(Distraction osteogenesis)is the lowest,followed by RAAllo,RAAuto(autologous bone and joint reconstruction),IGAAuto(autologous tissue graft interpositional gap arthroplasty),GA,IGAAllo.DO compared with GA,OR = 0.03,95%CI [0.00,0.19];DO compared with IGAAllo,OR = 0.03,95% CI [0.00,0.26];DO compared with IGAAuto,OR = 0.10,95% CI [0.01,0.56];DO compared with RAAuto,OR = 0.15,95% CI [0.02,0.87];GA Compared with IGAAuto,OR = 2.89,95%CI [1.36,7.46];GA Compared with RAAllo,OR = 5.76,95% CI [1.54,23.35];GA Compared with RAAuto,OR = 4.55,95% CI [2.03,12.20];IGAAllo Compared with RAAllo,OR = 5.97,95% CI [1.15,33.26];IGA Allo compared with RAAuto,OR = 4.68,95% CI [1.30,20.08].Bayesian mesh meta-analysis ranked the efficacy of 5 surgical methods and the recurrence rate of 6 surgical methods.The results showed that the order of opening degree was as follows: RAAllo >IGAAuto >IGAAllo > GA > RAAuto.The recurrence rates are sorted from large to small: IGAAllo> GA> IGAAuto> RAAuto>RAAllo> DO.Conclusion:1.When RA Allo is treating TMJA,the efficacy of mouth opening is better than other surgical methods,postoperative mouth opening can be restored to 2.5-3cm,and the recurrence rate is lower than other surgical methods,so it is recommended for clinical application.2.In clinical practice,artificial joint reconstruction is recommended for patients with a wide range of ankylosis;For patients with a small range of ankylosis,autologous tissue graft interposition arthroplasty is recommended.