Universidade Nove de Julho (UNINOVE), Conjunto Hospitalar Mandaqui, São Paulo, Brazil.
Universidade Metropolitana de Santos (UNIMES), Avenida Conselheiro Nébias, 536 -Encruzilhada, Santos, SP, 11045-002, Brazil.
Lasers Med Sci. 2020 Apr;35(3):513-522. doi: 10.1007/s10103-019-02779-4. Epub 2019 Apr 13.
Several therapeutic strategies have been proposed to optimize the conventional treatment of fractures. Photobiomodulation (PBM) appears to help reduce pain and control inflammation, and it also accelerates bone repair. This systematic review aimed to evaluate the effectiveness and safety of PBM with low-level laser therapy (LLLT) in the bone fracture healing process. We included randomized controlled trials (RCTs) comparing the effects of PBM with those of any other intervention in adults with lower or upper limb bone fractures. The primary outcomes investigated were pain reduction, radiographic healing, and adverse events. The searches were conducted in October 2018. Two RCTs were included that compared PBM to the placebo. A meta-analysis showed significant difference in favor of PBM for pain reduction (MD 1.19, 95% CI [0.61 to 1.77], 106 participants, two RCTs), but this difference was not clinically significant. One RCT (50 participants) showed a clinical and statistical improvement in physical function (MD - 14.60, 95% CI [- 21.39 to - 7.81]) and no difference in radiographic healing, regarding absence of fracture line (RR 1.00, 95% CI [0.93 to 1.08]) and visible bone callus (RR 0.33, 95% CI [0.01 to 7.81]). The certainty of evidence was classified as low to very low. Based on the evidence of low to very low certainty, PBM seems to be associated with the improvement of pain and function. Therefore, new RCTs are required that meet the recommendations of CONSORT to prove the effectiveness and safety of this intervention and support its recommendation in clinical practice.
已经提出了几种治疗策略来优化骨折的常规治疗。光生物调节（PBM）似乎有助于减轻疼痛和控制炎症，并且还能加速骨骼修复。本系统评价旨在评估低水平激光疗法（LLLT）联合 PBM 治疗骨折愈合过程的有效性和安全性。我们纳入了比较 PBM 与任何其他干预措施对上肢或下肢骨折成人影响的随机对照试验（RCT）。主要结局是疼痛减轻、影像学愈合和不良事件。检索于 2018 年 10 月进行。纳入的两项 RCT 比较了 PBM 与安慰剂。荟萃分析显示，PBM 在减轻疼痛方面具有显著优势（MD 1.19，95%CI [0.61 至 1.77]，106 名参与者，两项 RCT），但这种差异无临床意义。一项 RCT（50 名参与者）在物理功能方面显示出临床和统计学上的改善（MD -14.60，95%CI [-21.39 至 -7.81]），并且在影像学愈合方面无差异，无骨折线（RR 1.00，95%CI [0.93 至 1.08]）和可见骨痂（RR 0.33，95%CI [0.01 至 7.81]）。证据的确定性分级为低到极低。基于低到极低确定性的证据，PBM 似乎与疼痛和功能的改善有关。因此，需要新的 RCT 来证明该干预措施的有效性和安全性，并支持其在临床实践中的推荐，这些 RCT 应符合 CONSORT 的建议。
