Objective To use a meta-analytic technique to estimate the survival of implants between immediate loading/early loading and delayed loading. Methods We carried out a systematic search of electronic databases for all prospective trials comparing conventional delayed implant loading with early or immediate implant loading, reported between 1997 and 2007. The outcome of interest was implant failure rate. Quality assessment was performed for prospective trials that met the eligibility criteria and the data were then extracted and analyzed. Results Sixteen articles were found to meet the eligibility criteria, but two studies were reported in four articles, so that 14 articles were analyzed. There were five randomized controlled trials (RCTs). Compared to delayed loading, implant failure occurred sl ightly, but not statistically significant,less often with early implant loading (OR=0.54, 95%CI 0.22 to 1.33, P =0.18). We combined all cohort studies and this analysis was consistent with this result. Immediate implant loading was associated with slightly, but not statistically significant, worse outcomes (OR=1.51, 95%CI 0.53 to 4.25, P =0.44). We only pooled the RCTs and results showed better implant success rate with immediate implant loading, but with no significant difference. When sensitivity analyses were performed by the sequential dropping of a single study, no significant differences were observed except when the study of Jo et al was excluded. Conclusion Early implant loading was associated with better outcomes compared to delayed loading when the implants were placed into good quality bone. There was no significant difference of the implant success rate between immediate loading and delayed loading. Further evaluations in adequately powered large RCTs are needed to confirm these findings.
【摘要】 目的 探讨延期妊娠的结局及防治。 方法 回顾性分析2008年6月-2009年6月收治的1 157例延期妊娠临床资料，根据妊娠时段分A、B、C三组，A组449例，妊娠40+1~40+3周；B组358例，妊娠40+4~40+6周；C组350例，妊娠41~41+6周。比较各组羊水粪染发生率，剖宫产率，新生儿转归情况。 结果 随妊娠时段的延长，羊水粪染发生率，剖宫产率具有统计学意义的变化（Plt;0.05）。新生儿评分低，转专科治疗的新生儿增多。 结论 延期妊娠为高危妊娠，应加强监护及检测手段，适时终止妊娠。【Abstract】 Objective To explore the outcome of prolonged pregnancy and treatment. Methods Clinical data of 1 157 cases of prolonged pregnancy were retrospectively analyzed during June 2008 to June 2009.They were divided into three groups according to the time of pregnancy.Group A: 449 cases, pregnant age 40+1 - 40+3 week; Group B:358 cases, pregnant age 40+4 - 40+6 weeks; Group C:350 cases, pregnant age 41 - 41+6 weeks. The incidence of amniotic fluid turbidity, the rate of cesarean section and the neonatal prognosis were compared among three groups. Results With the extension of time of pregnancy, the incidence of amniotic fluid turbidity and the rate of cesarean section were statistically different among three groups (Plt;0.05), neonatal score was low, and the number of cases who needed specialist treatment increased. Conclusion Prolonged pregnancy is a high-risk pregnancy.The monitoring and detection means for prolonged pregnancy should be strengthened.Termination of pregnancy should be considered if necessary.
ObjectiveTo review and analyze the long-term results of delayed repair of median nerve injury. MethodsBetween January 2004 and December 2008, 228 patients with median nerve injury undergoing delayed repair were followed up for more than 4 years, and the clinical data were retrospectively analyzed. There were 176 males (77.19%) and 52 females (22.81%), aged 2-71 years (median, 29 years). The main injury reason was cutting injury in 159 cases (69.74%);203 cases had open injury (89.04%). According to the injury level, injury located at area I (upper arm) in 38 cases (16.67%), at area II (elbow and proximal forearm) in 53 cases (23.25%), at area III (anterior interosseous nerve) in 13 cases (5.70%), and at area IV (distal forearm to wrist) in 124 cases (54.39%). The delayed operations included delayed suture (50 cases, 21.93%), nerve release (149 cases, 65.35%), and nerve graft (29 cases, 12.72%). ResultsFor patients with injury at area I and area II, the results were good in 23 cases (25.27%), fair in 56 cases (61.54%), and poor in 12 cases (13.18%) according to modified Birch and Raji’s median nerve grading system;there was significant difference in the results between 3 repair methods for injury at area II (χ2=6.228, P=0.044), but no significant difference was found for injury at area I (χ2=2.241, P=0.326). Twelve patients (13.18%) needed musculus flexor functional reconstruction. Recovery of thenar muscle was poor in all patients, but only 5 cases (5.49%) received reconstruction. Thirteen cases of nerve injury at area III had good results, regardless of the repair methods. For patients with injury at area IV, the results were excellent in 6 cases (4.84%), good in 22 cases (17.74%), fair in 72 cases (58.06%), and poor in 24 cases (19.35%) according to Birch and Raji’s grading system;there was significant difference in the results between 3 repair methods (χ2=12.646, P=0.002), and the result of delayed repair was better. ConclusionThe results of delayed repair is poor for all median nerve injuries, especially for high level injury. The technique of repair methods vary with injury level. For some delayed median nerve injuries, early nerve transfer may be a better choice for indicative patients.
ObjectiveTo systematically review the implant survival and postoperative aesthetics of immediate versus delayed implant treatment in the anterior maxilla regions.MethodsWe searched databases including PubMed, The Cochrane Library, EMbase, CBM, CNKI and WanFang Data from inception to April 2017, to collect randomized controlled trials (RCTs) and cohort studies on immediate implant and delayed implant in the anterior teeth areas. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, RevMan 5.3 software was used to perform meta-analysis.ResultsA total of 4 RCTs and 12 retrospective cohort studies involving 1 316 implants were finally included. The results of meta-analysis showed that: there was no significant difference between two groups in retention rate (RCT: RR=0.99, 95%CI 0.97 to 1.02, P=0.70; retrospective cohort study: RR=0.99, 95%CI 0.96 to 1.02, P=0.54), the implant stability of permanent restoration for 4 months (MD=0.82, 95%CI –0.11 to 1.76, P=0.08), alveolar bone resorption of long-term permanent crown restoration (12 months: RCT: MD=0.06, 95%CI –0.35 to 0.47, P=0.79; retrospective cohort study: MD=–0.27, 95%CI –0.57 to 0.03, P=0.07; 24 months: retrospective cohort study MD=–0.09, 95%CI –0.18 to 0.00, P=0.05), respectively. The immediate implant group was superior to the control group in alveolar bone resorption of short-term permanent crown restoration (3 months: MD=–0.08, 95%CI –0.13 to –0.04, P=0.000 1; 6 months: MD=–0.23, 95%CI –0.38 to –0.07, P=0.004). The PES score in the immediate implant group was higher than that in the delayed implant group(MD=1.12, 95%CI 0.11 to 2.13, P=0.03).ConclusionsCurrent evidence shows that both immediate and delayed implant procedures have similar outcomes in terms of implant retention, long-term stability and long-term alveolar bone resorption of the implants in the anterior maxilla regions, but the former procedure possesses better short-term reduction of alveolar bone absorption and postoperative gingival aesthetics. Furthermore, due to the limited quality and quantity of the included studies, more large-scale and high-quality studies are needed to verify the above conclusions.
ObjectivesTo systematically review the differences of operative outcomes between early surgery and delayed surgery in multiple ligament injury of knee joint (MLIK) patients.MethodsPubMed, The Cochrane Library, EMbase, CNKI, CBM, WanFang Data and VIP databases were searched to collect cohort studies about operative outcomes of different surgery times in MLIK patients from inception to September 23rd, 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.ResultsA total of 8 cohort studies involving 153 early and 90 delayed operatively treated patients were included. The results of meta-analysis showed that: compared with delayed surgery, early surgery received higher Lysholm score (MD=7.52, 95%CI 2.00 to 13.04, P=0.008) and superior IKDC score rate (OR=2.97, 95%CI 1.51 to 5.84, P=0.002). There were no significant differences in Tegner score (MD=–0.08, 95%CI –1.07 to 0.92, P=0.88) and ROM (MD=4.08, 95%CI –2.38 to 10.55, P=0.22) between two groups. The main adverse reactions of MLIK included neurovascular injury, deep venous thrombosis of lower extremities, common peroneal nerve injury, tourniquet paralysis and limited joint activity. Early surgery had a lower incidence of complications than delayed surgery (7.1% vs. 30%).ConclusionThe current evidence shows that early surgery can receive higher Lysholm score and superior IKDC score rate in treatment of MLIK, and have a lower incidence of complications. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.