Griffin Xavier L, Costa Matthew L, Parsons Nick, Smith Nick
Warwick Orthopaedics, Warwick Medical School, University of Warwick, Clinical Sciences Building, Clifford Bridge Road, Coventry, UK, CV2 2DX.
Cochrane Database Syst Rev. 2011 Apr 13(4):CD008471. doi: 10.1002/14651858.CD008471.pub2.
Delayed union and non-union of fractures are a considerable cause of morbidity to patients. Laboratory studies have shown that electromagnetic fields can stimulate the formation of new bone, indicating a potential role for electromagnetic stimulation in the treatment of fractures that have failed to heal.
To assess the effects of electromagnetic stimulation for treating delayed union or non-union of long bone fractures in adults.
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (May 2010), the Cochrane Central Register of Controlled Trials (in The Cochrane Library 2010, Issue 2), MEDLINE (1966 to May 2010) and EMBASE (1980 to 2010 Week 20), trial registers and reference lists of articles.
Randomised controlled trials evaluating electromagnetic field stimulation for the treatment of delayed union or non-union of long bones in adults.
Two authors independently selected studies and performed data extraction and risk of bias assessment. Treatment effects were assessed using risk ratios and, where appropriate, data were pooled using a random-effects model.
Four studies, involving 125 participants, were included. Three studies evaluated the effects of pulsed electromagnetic fields and one study, capacitive coupled electric fields. Participants with delayed union and non-union of the long bones were included, but most data related to non-union of the tibia. Although all studies were blinded randomised placebo-controlled trials, each study had limitations.The primary measure of the clinical effectiveness of electromagnetic field stimulation was the proportion of participants whose fractures had united at a fixed time point. The overall pooled effect size was small and not statistically significant (risk ratio 1.96; 95% confidence interval 0.86 to 4.48; 4 trials). There was substantial clinical and statistical heterogeneity in this pooled analysis (I(2) = 58%). A sensitivity analysis conducted to determine the effect of multiple follow-up time-points on the heterogeneity amongst the studies showed that the effect size remained non-significant at 24 weeks (risk ratio 1.61; 95% confidence interval 0.74 to 3.54; 3 trials), with similar heterogeneity (I(2) = 57%).There was no reduction in pain found in two trials. No study reported functional outcome measures. One trial reported two minor complications resulting from treatment.
AUTHORS' CONCLUSIONS: Though the available evidence suggests that electromagnetic field stimulation may offer some benefit in the treatment of delayed union and non-union of long bone fractures, it is inconclusive and insufficient to inform current practice. More definitive conclusions on treatment effect await further well-conducted randomised controlled trials.
骨折的延迟愈合和不愈合是患者发病的一个重要原因。实验室研究表明，电磁场可刺激新骨形成，这表明电磁刺激在治疗骨折不愈合方面可能具有潜在作用。
评估电磁刺激治疗成人长骨骨折延迟愈合或不愈合的效果。
我们检索了Cochrane骨、关节和肌肉创伤组专业注册库（2010年5月）、Cochrane对照试验中央注册库（《Cochrane图书馆》2010年第2期）、MEDLINE（1966年至2010年5月）和EMBASE（1980年至2010年第20周）、试验注册库以及文章的参考文献列表。
评估电磁场刺激治疗成人长骨延迟愈合或不愈合的随机对照试验。
两位作者独立选择研究并进行数据提取和偏倚风险评估。使用风险比评估治疗效果，并在适当情况下使用随机效应模型汇总数据。
纳入了4项研究，涉及125名参与者。3项研究评估了脉冲电磁场的效果，1项研究评估了电容耦合电场的效果。纳入了长骨延迟愈合和不愈合的参与者，但大多数数据与胫骨不愈合有关。尽管所有研究均为双盲随机安慰剂对照试验，但每项研究都有局限性。电磁场刺激临床有效性的主要衡量指标是在固定时间点骨折已愈合的参与者比例。总体汇总效应量较小且无统计学意义（风险比1.96；95%置信区间0.86至4.48；4项试验）。该汇总分析存在显著的临床和统计学异质性（I² = 58%）。为确定多个随访时间点对研究间异质性的影响而进行的敏感性分析表明，在24周时效应量仍无统计学意义（风险比1.61；95%置信区间0.74至3.54；3项试验），异质性相似（I² = 57%）。两项试验未发现疼痛减轻。没有研究报告功能结局指标。一项试验报告了治疗导致的2例轻微并发症。
尽管现有证据表明电磁场刺激在治疗长骨骨折延迟愈合和不愈合方面可能有一定益处，但结论不明确，不足以指导当前实践。关于治疗效果的更明确结论有待进一步开展的高质量随机对照试验。
