Chen An-Fu, Huang Kai, Zhou Yong-Qiang
Department of Orthopaedics and Traumatology, the First Peoples Hospital of Neijiang, Neijiang 641000, Sichuan, China.
Zhongguo Gu Shang. 2020 Jan 25;33(1):87-92. doi: 10.3969/j.issn.1003-0034.2020.01.017.
To systematically evaluate the clinical effects of autologous bone grafting versus bone morphogenetic protein treatment for nonunion of long bone fractures in adults and provide reference for this fracture.
According to the methods of systematic review of Cochrane, the randomized controlled trials which compared autologous bone grafting with bone morphogenetic protein treatment for nonunion of long bone fractures in adults were searched in PuMed, Embase, Cochrane library, CNKI , Wangfang data and CBM from the databases were established to March 2019. Information was screened and extracted according to the inclusion and exclusion criteria by two researchers respectively, and the qualities of the included studies were assessed by the modified Jadad quality scale. The rate of infection, successful union, second operation, hospital stays and intraoperative blood loss were compared by RevMan 5.3 software from Cochrane Collaboration for Meta-analysis.
Seven randomized controlled trials with a total of 652 patients were included, 410 in the autologous bone grafting group and 242 in the bone morphogenetic protein group. Meta analysis showed there were no statistically significant differences regarding infection［=1.32, 95%CI (0.90, 1.93) , =0.16］, successful union［=0.95, 95%CI (0.84, 1.08) , =0.43］, second operation［=1.16, 95%CI (0.43, 3.12) , =0.76］, hospital stays［MD=0.69, 95%CI (-0.38, 1.75) , =0.21］between the two groups. But compared with the bone morphogenetic protein treatment, autologous bone grafting significantly increased the intraoperative blood loss［MD=223.00, 95%CI (32.72, 413.28) , =0.02］.
Since bone morphogenetic proteins can attain as the same fracture healing rate as autologous bone grafting and can significantly reduce the intraoperative blood loss, bone morphogenetic proteins may be a better choice for nonunion of long bone fractures in adults.
系统评价自体骨移植与骨形态发生蛋白治疗成人长骨骨折不愈合的临床效果，为该类骨折的治疗提供参考。
按照Cochrane系统评价方法，检索PubMed、Embase、Cochrane图书馆、中国知网、万方数据和中国生物医学文献数据库中比较自体骨移植与骨形态发生蛋白治疗成人长骨骨折不愈合的随机对照试验，检索时间截至2019年3月。由两名研究人员分别根据纳入和排除标准进行信息筛选和提取，采用改良Jadad质量量表对纳入研究的质量进行评估。采用Cochrane协作网的RevMan 5.3软件对感染率、骨折愈合成功率、二次手术率、住院时间和术中失血量进行Meta分析。
纳入7项随机对照试验，共652例患者，自体骨移植组410例，骨形态发生蛋白组242例。Meta分析显示，两组在感染率［比值比（OR）=1.32，95%可信区间（CI）（0.90，1.93），P=0.16］、骨折愈合成功率［OR=0.95，95%CI（0.84，1.08），P=0.43］、二次手术率［OR=1.16，95%CI（0.43，3.12），P=0.76］、住院时间［平均差（MD）=0.69，95%CI（-0.38，1.75），P=0.21］方面差异无统计学意义。但与骨形态发生蛋白治疗相比，自体骨移植显著增加了术中失血量［MD=223.00，95%CI（32.72，413.28），P=0.02］。
由于骨形态发生蛋白可达到与自体骨移植相同的骨折愈合率，且能显著减少术中失血量，因此骨形态发生蛋白可能是治疗成人长骨骨折不愈合的更好选择。
