自体骨移植与骨替代物手术治疗胫骨平台骨折的Meta分析  

Meta-analysis of autologous bone grafts and bone substitute for the treatment of tibial plateau fractures

作　　者：郭华[1,2] 黄凌岸 李皓乾 郭丽 李鹏翠[1,2] 卫小春 GUO Hua;HUANG Ling-an;LI Hao-qian;GUO Li;LI Peng-cui;WEI Xiao-chun(Department of Orthopaedics,second Hospital of Shanxi Medical University,Taiyuan 030001,Shanxi,China;Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair,Taiyuan 030001,Shanxi,China;Department of Pain Medicine,Sanya Central Hospital of Hainan Medical College,Sanya 572000,Hainan,China)

机构地区：[1]山西医科大学第二医院骨科,山西太原030001 [2]山西省骨与软组织损伤修复重点实验室,山西太原030001 [3]海南医学院三亚中心医院疼痛医学科,海南三亚572000

出　　处：《中国骨伤》2024年第3期300-305,共6页China Journal of Orthopaedics and Traumatology

基　　金：国家自然科学基金区域联合重点资助项目(编号:U21A20353);山西省基础研究计划自然科学研究面上项目(编号:20210302123285)。

摘　　要：目的:通过Meta分析系统评价自体骨移植和骨替代物治疗胫骨平台骨折的临床疗效。方法:计算机检索2005年1月至2022年8月PubMed、Web of Science、中国知网、万方等数据库已发表的关于自体骨移植和骨替代物治疗胫骨平台骨折的病例对照研究文献。根据纳排标准进行文献筛选及数据提取,对入选的随机对照研究(randomized controlled trial,RCT)采用Cochrane手册中的干预性Meta分析标准进行质量评价。采用RevMan 5.3软件对两种方法的关节凹陷、关节面二次塌陷率、失血量、手术时间和感染率进行Meta分析。结果:共纳入7项RCT研究,424例患者,其中骨替代物组296例,自体骨移植组128例。两组手术时间[MD=-16.79,95%CI(-25.72,-7.85),P=0.0002],出血量[MD=-70.49,95%CI(-79.34,-61.65),P<0.00001]比较,差异有统计学意义。而关节凹陷[MD=-0.17,95%CI(-0.91,0.58),P=0.66],关节面二次塌陷率[RR=-0.74,95%CI(0.35,1.57),P=0.43],感染率[RR=1.21,95%CI(0.31,4.70),P=0.78]比较,差异无统计学意义。结论:骨替代物与自体骨移植治疗胫骨平台骨折在关节凹陷、关节面二次塌陷率和感染率方面疗效相近。但骨替代物较自体骨移植,能减少失血量,缩短手术时间。Objective To explore clinical efficacy of autologous bone grafts and bone substitute for the treatment of tibial plateau fractures by Meta analysis.Methods Controlled clinical studies on autogenous bone transplantation and bone substitutes in treating tibial plateau fractures published on PubMed,Web of Science,CNKI,Wanfang and other databases from January 2005 to August 2022 were searched by computer.Literature screening and data extraction were performed according to randomized controlled trial(RCT),and the quality of RCT were evaluated by using intervention meta-analysis criteria in Cochrane manual.Meta-analysis of joint depression,secondary collapse rate of articular surface,blood loss,operative time and infection rate between two methods were performed by Rev Man 5.3 software.Results Seven RCT studies(424 patients)were included,296 patients in bone replacement group and 128 patients in autograft group.Operative time[MD=-16.79,95%CI(-25.72,-7.85),P=0.0002]and blood loss[MD=-70.49,95%CI(-79.34,-61.65),P<0.00001]between two groups had statistically differences,while joint depression[MD=-0.17,95%CI(-0.91,0.58),P=0.66],secondary collapse rate of joint surface[RR=-0.74,95%CI(0.35,1.57),P=0.43],infection rate[RR=1.21,95%CI(0.31,4.70),P=0.78]between two groups had no differences.Conclusion The effects of bone substitute and autograft for the treatment of tibial plateau fracture have similar effects in terms of joint depression,secondary articular surface collapse rate and infection rate.However,compared with autologous bone transplantation,bone replacement could reduce blood loss and shorten operation time.

关 键 词：胫骨平台骨折 自体骨移植 骨替代物 META分析 

分 类 号：R683.4[医药卫生—骨科学]