Cooper George M, Kennedy Matthew J, Jamal Bilal, Shields David W
Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK.
Department of Orthopaedics, Forth Valley Royal Hospital, Larbert, UK.
Bone Jt Open. 2022 Mar;3(3):218-228. doi: 10.1302/2633-1462.33.BJO-2021-0195.R1.
Our objective was to conduct a systematic review and meta-analysis, to establish whether differences arise in clinical outcomes between autologous and synthetic bone grafts in the operative management of tibial plateau fractures.
A structured search of MEDLINE, EMBASE, the online archives of Bone & Joint Publishing, and CENTRAL databases from inception until 28 July 2021 was performed. Randomized, controlled, clinical trials that compared autologous and synthetic bone grafts in tibial plateau fractures were included. Preclinical studies, clinical studies in paediatric patients, pathological fractures, fracture nonunion, or chondral defects were excluded. Outcome data were assessed using the Risk of Bias 2 (ROB2) framework and synthesized in random-effect meta-analysis. The Preferred Reported Items for Systematic Review and Meta-Analyses guidance was followed throughout.
Six studies involving 353 fractures were identified from 3,078 records. Following ROB2 assessment, five studies (representing 338 fractures) were appropriate for meta-analysis. Primary outcomes showed non-significant reductions in articular depression at immediate postoperative (mean difference -0.45 mm, p = 0.25, 95%confidence interval (CI) -1.21 to 0.31, I = 0%) and long-term (> six months, standard mean difference -0.56, p = 0.09, 95% CI -1.20 to 0.08, I = 73%) follow-up in synthetic bone grafts. Secondary outcomes included mechanical alignment, limb functionality, and defect site pain at long-term follow-up, perioperative blood loss, duration of surgery, occurrence of surgical site infections, and secondary surgery. Mean blood loss was lower (90.08 ml, p < 0.001, 95% CI 41.49 to 138.67) and surgery was shorter (16.17 minutes, p = 0.04, 95% CI 0.39 to 31.94) in synthetic treatment groups. All other secondary measures were statistically comparable.
All studies reported similar methodologies and patient populations; however, imprecision may have arisen through performance variation. These findings supersede previous literature and indicate that, despite perceived biological advantages, autologous bone grafting does not demonstrate superiority to synthetic grafts. When selecting a void filler, surgeons should consider patient comorbidity, environmental and societal factors in provision, and perioperative and postoperative care provision. Cite this article: 2022;3(3):218-228.
我们的目标是进行一项系统评价和荟萃分析，以确定在胫骨平台骨折的手术治疗中，自体骨移植和人工合成骨移植在临床结局上是否存在差异。
对MEDLINE、EMBASE、骨与关节出版在线存档库以及CENTRAL数据库进行结构化检索，检索时间从建库至2021年7月28日。纳入比较胫骨平台骨折中自体骨移植和人工合成骨移植的随机对照临床试验。排除临床前研究、儿科患者的临床研究、病理性骨折、骨折不愈合或软骨缺损。使用偏倚风险2（ROB2）框架评估结局数据，并在随机效应荟萃分析中进行综合分析。自始至终遵循系统评价和荟萃分析的首选报告项目指南。
从3078条记录中识别出6项涉及353例骨折的研究。经过ROB2评估，5项研究（代表338例骨折）适合进行荟萃分析。主要结局显示，在术后即刻（平均差异-0.45mm，p=0.25，95%置信区间（CI）-1.21至0.31，I²=0%）和长期（>6个月，标准化平均差异-0.56，p=0.09，95%CI-1.20至0.08，I²=73%）随访时，人工合成骨移植组关节面塌陷的减少无统计学意义。次要结局包括长期随访时的机械对线、肢体功能和缺损部位疼痛、围手术期失血量、手术时间、手术部位感染的发生率以及二次手术。人工合成骨移植治疗组的平均失血量较低（90.08ml，p<0.001，95%CI 41.49至138.67），手术时间较短（16.17分钟，p=0.04，95%CI 0.39至31.94）。所有其他次要指标在统计学上具有可比性。
所有研究报告的方法和患者群体相似；然而，可能由于性能差异而产生不精确性。这些发现取代了以往的文献，表明尽管自体骨移植具有生物学优势，但并不优于人工合成骨移植。在选择骨缺损填充材料时，外科医生应考虑患者的合并症、供应中的环境和社会因素以及围手术期和术后护理。引用本文：2022；3(3)：218-228。
