腰椎融合中自体髂骨植骨与骨形态发生蛋白2比较的Meta分析  

Autogeneic iliac crest graft versus bone morphogenetic protein 2 in lumbar fusion: a Meta-analysis

作　　者：张海飞[1] 张治宇[1] 崔岩[1] 王锋[1] 马承斌[1] 张伟[1] 

机构地区：[1]中国医科大学附属第四医院骨外科,辽宁省沈阳市110032

出　　处：《中国组织工程研究》2016年第43期6521-6529,共9页Chinese Journal of Tissue Engineering Research

摘　　要：背景:骨形态发生蛋白2作为自体髂骨的替代已被广泛应用于临床及相关试验中。目的:评估腰椎融合中骨形态发生蛋白2的有效性和安全性。方法:检索2015年9月前中国生物医学文献数据库、Medline、Embase及Cochrane Central Register of Controlled Trial等数据库中,有关腰椎融合中骨形态发生蛋白2与自体髂骨植骨效果比较的随机对照试验,采用Cochrane系统进行Meta分析。结果与结论:共纳入14篇随机对照试验,总共1 613例患者。Meta分析结果显示,骨形态发生蛋白2组二次手术率、手术时间少于自体髂骨植骨组(P≤0.01),融合率高于自体髂骨植骨组(P≤0.01);两组间总体疗效、并发症、术中出血量、住院时间、患者满意度及术后工作情况等比较差异均无显著性意义。基于有限的证据,相较于自体髂骨植骨,骨形态发生蛋白2治疗腰椎退行性疾病并没有显著的优越性,评估骨形态发生蛋白2应用于腰椎融合手术的有效性和安全性,需要更多高质量的并有长期随访的随机对照试验。BACKGROUND： As a substitute for autogeneic iliac crest, bone morphogenetic protein 2 has been widely used in lumbar fusion and relative trials. OBJECTIVE： To assess the effectiveness and safety of bone morphogenetic protein 2 in lumbar fusion. METHODS： CBM, Medline, Embase and the Cochrane Central Register of Controlled Trial databases were retrieved for relevant randomized controlled trials of bone morphogenetic protein 2 versus autogenous iliac crest graft in lumbar fusion published before September 2015. A Meta-analysis was performed utilizing the Cochrane system. RESULTS AND CONCLUSION： Totally 14 randomized controlled trials met the inclusion criteria, including 1 613 patients. Meta-analysis results showed that the reoperation rate and operation time in bone morphogenetic protein 2 group were significantly less than those in the autogenous iliac crest graft group （P ≤ 0.01）, and the fusion rate was significantly higher than that in the autologous lilac crest graft group （P ≤0.01）. There were no significant differences in the clinical outcomes, complications, intraoperative blood loss, hospitalization time, patient satisfaction and work status after surgery between two groups. Based on the limited evidence, bone morphogenetic protein 2 for lumbar degenerative disease exerts no significant superiority to the autologous lilac crest graft. Moreover, more high-quality randomized controlled trials with long-term follow-up are needed to further assess the effectiveness and safety of bone morphogenetic protein 2 in lumbar fusion.

关 键 词：骨形态发生蛋白质类 脊柱融合术 随机对照试验 组织工程 生物材料 骨生物材料 骨形态发生蛋白2 腰椎融合 腰椎退行性疾病 腰痛 自体髂骨 META分析 

分 类 号：R318[医药卫生—生物医学工程]