Department one of Orthopedics, Affiliated Hospital of Beihua University, Jilin, Jilin, China.
Department of Orthopedics, Yixing People's Hospital, Yixing, Jiangsu, China.
Int J Clin Pract. 2021 Apr;75(4):e13911. doi: 10.1111/ijcp.13911. Epub 2020 Dec 14.
The impact of bone morphogenetic protein-2 compared to autologous iliac crest bone graft to improve fusion rates for the posterolateral fusion of the lumbar spine remains inconclusive. This meta-analysis was performed to evaluate this relationship.
A systematic literature search up to May 2020 was performed and 14 studies were detected with 1516 subjects with 789 of them were bone morphogenetic protein-2 and 727 of them were autologous iliac crest bone graft. They reported relationships between bone morphogenetic protein-2 and autologous iliac crest bone graft on fusion rates for the posterolateral fusion of the lumbar spine. Odds ratio (OR) with 95% confidence intervals (CIs) was calculated comparing the bone morphogenetic protein-2 or autologous iliac crest bone graft on the posterolateral fusion of the lumbar spine risks using the dichotomous and continuous method with a random- or fixed-effect model.
Bone morphogenetic protein-2 had significantly higher fusion rates (OR, 4.19; 95% CI, 2.82-6.20, P < .001); lower surgery time (OR, -26.64; 95% CI, -38.71 to -14.57, P < .001); lower blood loss (OR, -92.84; 95% CI, -131.71 to -53.97, P < .001); lower additional surgical procedures (OR, 0.46; 95% CI, 0.31-0.69, P < .001) and higher Oswestry Disability Index (OR, 1.49; 95% CI, 0.02-2.97, P = .05) compared to autologous iliac crest bone graft. However, no significant difference was found between bone morphogenetic protein-2 and autologous iliac crest bone graft in non-union rates (OR, 0.34; 95% CI, 0.08-1.53, P < .001); hospitalisation days (OR, -0.21; 95% CI, -0.48 to 0.07, P = .14) and adverse events (OR, 0.78; 95% CI, 0.52-1.16, P = .22).
Bone morphogenetic protein-2 significantly had a higher fusion rate, lower surgery time, lower blood loss, lower additional surgical procedures and higher Oswestry Disability Index compared to autologous iliac crest bone graft. This relationship forces us to recommend bone morphogenetic protein-2 for the posterolateral fusion of the lumbar spine to avoid any possible negative postoperative results.
骨形态发生蛋白-2 与自体髂嵴骨移植物相比，对改善腰椎后路融合率的影响仍不确定。进行这项荟萃分析是为了评估这种关系。
系统检索至 2020 年 5 月，共发现 14 项研究，纳入 1516 例受试者，其中 789 例接受骨形态发生蛋白-2 治疗，727 例接受自体髂嵴骨移植物治疗。他们报告了骨形态发生蛋白-2 与自体髂嵴骨移植物在腰椎后路融合中的融合率之间的关系。使用二项和连续方法，随机或固定效应模型，计算骨形态发生蛋白-2 或自体髂嵴骨移植物治疗腰椎后路融合的风险之间的比值比（OR），95%置信区间（CI）。
骨形态发生蛋白-2 组融合率显著较高（OR，4.19；95%CI，2.82-6.20，P<0.001）；手术时间较短（OR，-26.64；95%CI，-38.71 至-14.57，P<0.001）；出血量较少（OR，-92.84；95%CI，-131.71 至-53.97，P<0.001）；附加手术程序较少（OR，0.46；95%CI，0.31-0.69，P<0.001），Oswestry 残疾指数较高（OR，1.49；95%CI，0.02-2.97，P=0.05）与自体髂嵴骨移植物相比。然而，骨形态发生蛋白-2 组与自体髂嵴骨移植物组的非融合率（OR，0.34；95%CI，0.08-1.53，P<0.001）、住院天数（OR，-0.21；95%CI，-0.48 至 0.07，P=0.14）和不良事件（OR，0.78；95%CI，0.52-1.16，P=0.22）差异无统计学意义。
骨形态发生蛋白-2 与自体髂嵴骨移植物相比，融合率显著提高，手术时间缩短，出血量减少，附加手术减少，Oswestry 残疾指数升高。这种关系迫使我们推荐骨形态发生蛋白-2 用于腰椎后路融合，以避免任何可能的术后不良结果。
