Bajammal Sohail S, Zlowodzki Michael, Lelwica Amy, Tornetta Paul, Einhorn Thomas A, Buckley Richard, Leighton Ross, Russell Thomas A, Larsson Sune, Bhandari Mohit
Division of Orthopaedic Surgery, University of Calgary, 3330 Hospital Drive N.W., Calgary, AB T2N 4N1, Canada.
J Bone Joint Surg Am. 2008 Jun;90(6):1186-96. doi: 10.2106/JBJS.G.00241.
Available options to fill fracture voids include autogenous bone, allograft bone, and synthetic bone materials. The objective of this meta-analysis was to determine whether the use of calcium phosphate bone cement improves clinical and radiographic outcomes and reduces fracture complications as compared with conventional treatment (with or without autogenous bone graft) for the treatment of fractures of the appendicular skeleton in adult patients.
Multiple databases, online registers of randomized controlled trials, and the proceedings of the meetings of major national orthopaedic associations were searched. Published and unpublished randomized controlled trials were included, and data on methodological quality, population, intervention, and outcomes were abstracted in duplicate. Data were pooled across studies, and relative risks for categorical outcomes and weighted mean differences for continuous outcomes, weighted according to study sample size, were calculated. Heterogeneity across studies was determined, and sensitivity analyses were conducted.
We identified eleven published and three unpublished randomized controlled trials. Of the fourteen studies, six involved distal radial fractures, two involved femoral neck fractures, two involved intertrochanteric femoral fractures, two involved tibial plateau fractures, one involved calcaneal fractures, and one involved multiple types of metaphyseal fractures. All of the studies evaluated the use of calcium phosphate cement for the treatment of metaphyseal fractures occurring primarily through trabecular, cancellous bone. Autogenous bone graft was used in the control group in three studies, and no graft material was used in the remaining studies. Patients managed with calcium phosphate had a significantly lower prevalence of loss of fracture reduction in comparison with patients managed with autograft (relative risk reduction, 68%; 95% confidence interval, 29% to 86%) and had less pain at the fracture site in comparison with controls managed with no graft (relative risk reduction, 56%; 95% confidence interval, 14% to 77%). We were unable to compare pain at the bone-graft donor site between the studies because of methodological reasons. Three studies independently demonstrated improved functional outcomes when the use of calcium phosphate was compared with the use of no grafting material.
The use of calcium phosphate bone cement for the treatment of fractures in adult patients is associated with a lower prevalence of pain at the fracture site in comparison with the rate in controls (patients managed with no graft material). Loss of fracture reduction is also decreased in comparison with that in patients managed with autogenous bone graft.
用于填充骨折间隙的现有选择包括自体骨、同种异体骨和合成骨材料。本荟萃分析的目的是确定与传统治疗（使用或不使用自体骨移植）相比，使用磷酸钙骨水泥治疗成年患者四肢骨骼骨折是否能改善临床和影像学结果并减少骨折并发症。
检索了多个数据库、随机对照试验的在线注册库以及主要国家骨科协会会议的论文集。纳入已发表和未发表的随机对照试验，并对方法学质量、人群、干预措施和结果的数据进行了重复提取。对各研究的数据进行汇总，并根据研究样本量加权计算分类结果的相对风险和连续结果的加权平均差。确定研究间的异质性，并进行敏感性分析。
我们确定了11项已发表和3项未发表的随机对照试验。在这14项研究中，6项涉及桡骨远端骨折，2项涉及股骨颈骨折，2项涉及股骨转子间骨折，2项涉及胫骨平台骨折，1项涉及跟骨骨折，1项涉及多种类型的干骺端骨折。所有研究均评估了磷酸钙骨水泥用于治疗主要发生于小梁骨、松质骨的干骺端骨折的情况。3项研究的对照组使用了自体骨移植，其余研究未使用移植材料。与自体骨移植治疗的患者相比，使用磷酸钙治疗的患者骨折复位丢失的发生率显著更低（相对风险降低68%；95%置信区间，29%至86%），与未使用移植材料的对照组相比，骨折部位疼痛更少（相对风险降低56%；95%置信区间，14%至77%）。由于方法学原因，我们无法在各研究之间比较骨移植供区的疼痛情况。3项研究独立表明，与不使用移植材料相比，使用磷酸钙时功能结果有所改善。
与对照组（未使用移植材料治疗的患者）相比，使用磷酸钙骨水泥治疗成年患者骨折时，骨折部位疼痛的发生率更低。与自体骨移植治疗的患者相比，骨折复位丢失的情况也有所减少。
