骨形态发生蛋白与自体骨移植治疗四肢长骨骨不连的Meta分析  

Meta-analysis of bone morphogenetic protein versus autologous bone grafting for limb long bone nonunion

作　　者：谢程欣 余城墙 王维 王成龙 尹东[2] Xie Chengxin;Yu Chengqiang;Wang Wei;Wang Chenglong;Yin Dong(Graduate School of Guangxi University of Chinese Medicine,Nanning 530200,Guangxi Zhuang Autonomous Region,China;Department of Orthopedics,The People’s Hospital of Guangxi Zhuang Autonomous Region,Nanning 530021,Guangxi Zhuang Autonomous Region,China)

机构地区：[1]广西中医药大学研究生院,广西壮族自治区南宁市530200 [2]广西壮族自治区人民医院骨科,广西壮族自治区南宁市530021

出　　处：《中国组织工程研究》2020年第5期803-810,共8页Chinese Journal of Tissue Engineering Research

摘　　要：背景:骨形态发生蛋白具有强大的骨诱导特性,已被证实能够促进骨折、骨缺损等疾病的骨愈合。但目前国内外针对骨形态发生蛋白用于治疗骨不连的研究较少,并且各研究结果间存在争议,使得骨形态发生蛋白治疗四肢长骨骨不连的疗效尚不明确。目的:通过Meta分析,系统评价骨形态发生蛋白相比自体骨移植治疗四肢长骨骨不连的优势和不足。方法:计算机检索Pub Med、Elsevier、Web of Science、Cochrane Library、CNKI及万方等数据库建库至2019年4月发表的文献,筛选出与骨形态发生蛋白治疗四肢长骨骨不连相关的随机或非随机临床对照研究,并对纳入的文献进行质量评价和数据提取,采用Cochrane系统提供的Rev Man5.1软件对结局指标进行Meta分析。结果与结论:(1)共纳入8篇文献,其中随机对照试验和非随机对照试验各4篇,多为30-124例的小样本量研究,共计613例骨不连患者,观察组采用骨形态发生蛋白或骨形态发生蛋白联合骨移植,对照组采用自体骨移植;(2)Meta分析显示:骨形态发生蛋白或骨形态发生蛋白联合骨移植与自体骨移植的术后愈合率、感染率、二次手术率比较差异无显著性意义(P> 0.05);骨形态发生蛋白联合骨移植与自体骨移植的术后功能优良率比较差异无显著性意义(P>0.05);骨形态发生蛋白联合自体骨移植的平均愈合时间短于自体骨移植[WMD=-1.24,95%CI(-1.70,-0.79),P <0.01];骨形态发生蛋白或骨形态发生蛋白联合骨移植的手术时间短于自体骨移植(P <0.01);单独应用骨形态发生蛋白的术中出血量少于自体骨移植(P <0.05);骨形态发生蛋白联合自体骨移植的治疗费用高于自体骨移植(P <0.01);单独应用骨形态发生蛋白与自体骨移植的住院时间比较差异无显著性意义(P>0.05);(3)结果表明骨形态发生蛋白能够为自体骨移植提供一种可行的替代方法,同时也是自体骨移植物的安全佐剂,具有BACKGROUND:Bone morphogenetic proteins have strong bone induction properties and have been proved to promote bone healing in fracture,bone defect and other diseases.However,few studies are reported on the use of bone morphogenetic proteins in the treatment of bone nonunion,and the results of various studies remain controversial,which makes the role of bone morphogenetic proteins in the treatment of limb long bone nonunion unclear.OBJECTIVE:Meta-analysis was used to systematically evaluate the advantages and disadvantages of bone morphogenetic protein versus autogenous bone grafting in the treatment of limb long bone nonunion.METHODS:PubMed,Elsevier,Web of Science,Cochrane Library,CNKI and Wan Fang databases were searched to retrieve the randomized controlled trials and non-randomized controlled trials of bone morphogenetic proteins for limb long bone nonunion published before April 2019 Quality evaluation and data extraction of the included literatures were performed.Meta-analysis of outcome indicators was performed using RevMan 5.1 software provided by Cochrane system.RESULTS AND CONCLUSION:Eight articles were enrolled,including 4 randomized controlled trials and 4 non-randomized controlled trials,all of which were small sample-size studies involving 30-124 cases.A total of 613 cases of nonunion were included.In the study group,patients received bone morphogenetic proteins or bone morphogenetic proteins in combination with bone grafting.In the control group,patients received autologous bone grafting.Meta-analysis results showed that there were no significant differences in postoperative healing rate,infection rate,secondary operation rate,and postoperative improvement in limb function between study and control groups(P> 0.05).The mean healing time in the study group was significantly shorter than that in the control group [WMD=-1.24,95%C/(-1.70,-0.79),P<0.01].Intraoperative blood loss in patients receiving simple bone morphogenetic protein was less than that in patients receiving autologous bone grafting(P<0.05)

关 键 词：骨形态发生蛋白 成骨蛋白1 自体骨移植 骨不连 长骨 愈合率 感染率 META分析 

分 类 号：R459.9[医药卫生—治疗学] R628[医药卫生—临床医学]