富血小板纤维蛋白在下颌第三磨牙拔除术的应用系统评价与Meta分析

doi:10.7518/hxkq.2021.05.017

华西口腔医学杂志 ›› 2021, Vol. 39 ›› Issue (5): 605-611.doi: 10.7518/hxkq.2021.05.017

富血小板纤维蛋白在下颌第三磨牙拔除术的应用系统评价与Meta分析

包明哲¹(), 刘伟¹, 余树容², 门乙¹, 韩波¹, 李春洁¹()

^1.口腔疾病研究国家重点实验室国家口腔疾病临床医学研究中心四川大学华西口腔医院头颈肿瘤外科，成都 610041
^2.西南医科大学附属中医医院口腔科，泸州 646000

收稿日期:2020-10-21 修回日期:2021-07-09 出版日期:2021-10-01 发布日期:2021-10-11
通讯作者: 李春洁 E-mail:1194164132@qq.com;lichunjie@scu.edu.cn
作者简介:包明哲，学士，E-mail：1194164132@qq.com
基金资助:
四川大学-泸州市人民政府战略合作专项资金项目(20-18CDLZ-12)

Application of platelet-rich fibrin on mandibular third molar extraction: systematic review and Meta-analysis

Bao Mingzhe¹(), Liu Wei¹, Yu Shurong², Men Yi¹, Han Bo¹, Li Chunjie¹()

^1.State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
^2.Dept. of Stomatology, Hospital of Traditional Chinese Medicine Affiliated to Southwest Medical University, Luzhou 646000, China

Received:2020-10-21 Revised:2021-07-09 Online:2021-10-01 Published:2021-10-11
Contact: Li Chunjie E-mail:1194164132@qq.com;lichunjie@scu.edu.cn
Supported by:
Sichuan University-Luzhou Municipal Government Strategic Cooperation Research(2018CDLZ-12);Correspondence: Li Chunjie, E-mail: lichunjie@scu.edu.cn

摘要/Abstract

摘要： 目的

通过系统评价及Meta分析的方法评估下颌第三磨牙拔除术中使用富血小板纤维蛋白（PRF）的有效性，为缓解术后并发症提供建议。

方法

对Pubmed、EMBASE、Web of Science和中国生物医学文献数据库针对在下颌第三磨牙术中使用PRF的临床随机对照试验进行电子检索，检索时间截至2020年2月。评价者使用Cochrane协作网推荐的标准对纳入文献进行偏倚风险评价并提取数据。运用RevMan 5.3和STATA 13.0进行Meta分析。

结果

共纳入21篇研究，包括991位拔除下颌第三磨牙患者。分析结果表明，局部应用PRF可以有效减轻拔牙术后疼痛[MD=-12.06，95%CI（-21.42，-2.71），P=0.01]，降低拔牙后肿胀程度[MD=-1.42，95%CI（-2.41，-0.44），P=0.005]，促进软组织愈合[MD=0.66，95%CI（0.34，0.99），P<0.000 1]，同时能够有效改善术后张口受限、减少干槽症的发生（P<0.05），但在骨愈合方面PRF组与对照组差异无统计学意义（P>0.05）。

结论

目前有限的临床证据显示，下颌第三磨牙拔除术后使用PRF可以改善疼痛、肿胀、张口受限，减少干槽症的发生并促进软组织愈合。但是其对于骨愈合的影响需要进一步进行大规模的随机对照试验并统一测量标准后进行分析。

关键词: 富血小板纤维蛋白, 下颌第三磨牙拔除术, Meta分析, 系统评价

Abstract: Objective

This study aims to analyze the effectiveness of platelet-rich fibrin (PRF) in mandibular third molar extraction and provide suggestions for alleviating postoperative complications.

Methods

Pubmed, EMBASE, Web of Science, and SinoMed were searched electronically on February 2020. Randomized controlled trials focusing on PRF usage in mandibular third molar extraction were included. Reviewers assessed the risk of bias in the included literature and extracted data independently using the criteria recommended by the Cochrane Collaboration. Meta-analysis was performed using RevMan 5.3 and STATA 13.0.

Results

Twenty-one studies were included, comprising 991 patients who had mandibular third molar extraction. The topical application of PRF effectively reduced pain after extraction [MD=-12.06, 95%CI (-21.42, -2.71), P=0.01], attenuated post-extraction swelling [MD=-1.42, 95%CI (-2.41, -0.44), P=0.005], and promoted soft tissue hea-ling [MD=0.66, 95%CI (0.34, 0.99), P<0.000 1]. PRF significantly reduced trismus and alveolar osteitis (P<0.05). However, data could not prove whether PRF has any significant positive effect on bone healing compared with the control group (P>0.05).

Conclusion

Limited clinical evidence indicates that applying PRF after mandibular third molar extraction could reduce pain, swelling, trismus and the occurrence of dry socket and promote soft tissue healing. However, the effect of PRF on bone healing requires further large-scale randomized controlled trials and unified measurement criteria.

Key words: platelet-rich fibrin, mandibular third molar extraction, Meta-analysis, systematic review

中图分类号:

R 782.11

包明哲, 刘伟, 余树容, 门乙, 韩波, 李春洁. 富血小板纤维蛋白在下颌第三磨牙拔除术的应用系统评价与Meta分析[J]. 华西口腔医学杂志, 2021, 39(5): 605-611.

Bao Mingzhe, Liu Wei, Yu Shurong, Men Yi, Han Bo, Li Chunjie. Application of platelet-rich fibrin on mandibular third molar extraction: systematic review and Meta-analysis[J]. West China Journal of Stomatology, 2021, 39(5): 605-611.

图/表 10

图 1

表 1

纳入研究的主要特征

作者	国籍	研究设计	平均年龄/岁	M/F	参与人数	PRF组	对照组	手术次数	骨移除	PRF制备	联合干预
Dar等^[8]	印度	RCT（sm）	23.6（18~50）	13∶17	30	30	30	2	Yes	10 mL，3 000 r·min^-1，12 min	ATB-NSAID
Jeyaraj等^[9]	印度	RCT（pa）	>18	NR	60	30	30	1	Yes	10 mL，2 700 r·min^-1，12 min	ATB-NSAID
Kapse等^[10]	印度	RCT（sm）	18~40	13∶17	30	30	30	2	Yes	10 mL，2 700 r·min^-1，12 min	NR
Revathy等^[11]	印度	RCT（sm）	18~35	15∶10	25	25	25	1	No	15 mL，3 000 r·min^-1，10 min	ATB-NSAID
王敏等^[12]	中国	RCT（pa）	21.4（18~25）	34∶46	80	40	40	1	No	NR	NR
Eshghpour等^[13]	爱尔兰	RCT（sm）	24（18~35）	99∶142	241	118	118	1	Yes	10 mL，3 000 r·min^-1，10 min	ATB-NSAID
Güls?en等^[14]	土耳其	RCT（sm）	20.03（17~27）	21∶9	30	30	30	1	Yes	10 mL，3 000 r·min^-1，10 min	ATB-NSAID
Unsal等^[15]	土耳其	RCT（sm）	23.96（15~43）	17∶33	50	50	50	2	Yes	10 mL，3 000 r·min^-1，10 min	ATB-NSAID
Varghese等^[16]	印度	RCT（sm）	18~35	-	30	30	30	1	Yes	5~10 mL，3 000 r·min^-1，10 min	NR
Al-Hamed等^[17]	埃及	RCT（pa）	25.24（18-48）	13∶34	47	25	25	1	Yes	5 mL，3 000 r·min^-1，10 min	ATB-NSAID
Bilginaylar^[18]	塞浦路斯	RCT（pa）	18~31	22∶37	59	40	40	1	Yes	10 mL，3 000 r·min^-1，10 min	ATB-NSAID
Doiphode等^[19]	印度	RCT（pa）	18~30	-	30	15	15	1	NR	5 mL，3 000 r·min^-1，10 min	NR
Dutta等^[20]	印度	RCT（pa）	27（17~36）	13∶27	40	10	10	1	No	5 mL，2 000 r·min^-1，15 min	NR
Kumar等^[21]	印度	RCT（sm）	18~40	-	34	34	34	NR	Yes	NR	ATB-NSAID
Baslarli等^[22]	土耳其	RCT（sm）	23.9（19~34）	7∶13	20	20	20	1	No	9 mL，3 000 r·min^-1，10 min	ATB-NSAID
Uyanik等^[23]	塞浦路斯	RCT（sm）	22.5（19~31）	10∶10	20	20	20	2	Yes	10 mL，3 000 r·min^-1，10 min	ATB-NSAID
Kumar等^[24]	印度	RCT（pa）	26.1（19~35）	-	31	16	15	2	Yes	5 mL，3 000 r·min^-1，10 min	ATB-NSAID
Ozgul等^[25]	土耳其	RCT（sm）	NR	23∶33	56	56	56	1	No	10 mL，3 000 r·min^-1，10 min	ATB-NSAID
Eshghpour等^[26]	爱尔兰	RCT（sm）	25.1（18~35）	33∶45	78	78	78	1	Yes	10 mL，3 000 r·min^-1，10 min	ATB-NSAID
Singh等^[27]	土耳其	RCT（sm）	32（18~50）	10∶10	20	20	20	1	NR	5~10 mL，3 000 r·min^-1，10 min	NR
Gürbürzer等^[28]	土耳其	RCT（sm）	24.9（NR）	7∶7	14	14	14	1	No	10 mL，2 030 r·min^-1，10 min	ATB-NSAID

表 1

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图 8

图 9

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富血小板纤维蛋白在下颌第三磨牙拔除术的应用系统评价与Meta分析

Application of platelet-rich fibrin on mandibular third molar extraction: systematic review and Meta-analysis

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