骨形态发生蛋白治疗开放性胫骨骨折的Meta分析

目的:系统评价骨形态发生蛋白(BMP)治疗开放性胫骨骨折的疗效。方法:计算机检索Cochrane Library、PubMed、EMBASE、中国生物医学文献数据库、中国期刊全文数据库和维普数据库,并手工检索相关领域杂志。检索不受语种限制,时间均从建库至2012年4月,收集骨形态发生蛋白治疗开放性胫骨骨折的所有随机对照试验。根据Cochrane协作网推荐的"风险评估工具"进行偏倚风险评估,用RevMan 5.1软件进行统计学分析。结果:最终纳入3个随机对照试验,共851例患者。研究结果显示:和对照组相比,BMP治疗开放性胫骨骨折未提高其骨折愈合率RR=1.16,95%CI(0.95,1.41),P=0.15],但是可减少二次干预发生情况RR=0.72,95%CI(0.58,0.89),P=0.003];在不良事件发生率方面,BMP治疗开放性胫骨骨折后发生感染RR=1.31,95%CI(0.94,1.81),P=0.11]和疼痛的不良事件RR=0.92,95%CI(0.79,1.08),P=0.30]与对照组差异无统计学意义。结论:骨形态发生蛋白治疗开放性胫骨骨折有一定的效果。由于纳入研究质量和病例数量的局限,上述结论尚需要更多高质量的随机对照试验进一步验证。

A meta-analysis of bone morphogenetic protein for the treatment of open tibial fractures

Objective:To systematically assess the clinical efficacy of bone morphogenetic proteins in the treatment of open tibial fractures. Methods:Based on the principles and methods of Cochrane systematic reviews,the Cochrane Library,PubMed,EMBASE,Chinese Bio-medicine Database,China Journal Full-text Database,VIP database were searched from their establishment to April 2012 in whatever language. Related journals were handsearched as well. Randomized controlled trials (RCTs) of bone morphogenetic protein for the treatment of open tibial fractures were included. The quality of the included trials according to the Cochrane Handbook for Systematic Reviews of Interventions Version was assessed. The Cochrane Collaboration's software RevMan 5.1 was used for meta-analysis. Results:Three RCTs totaling 851 patients were included. The results showed that bone morphogenetic protein had no significant differences in fracture healing RR=1.16,95%CI(0.95,1.41),P=0.15],but lower secondary interventions incidence rateRR=0.72,95%CI(0.58,0.89),P=0.003]. There were no significant differences between the two groups in the incidence of adverse events of infection RR=1.31,95%CI(0.94,1.81),P=0.11] and painRR=0.92,95%CI(0.79,1.08),P=0.30]. Conclusion:Bone morphogenetic protein has certain advantages in treating open tibial fractures. It needs more high-quality articles to assess the long-term effect of different courses of treatments. The above conclusion still needs more high-quality randomized controlled trails to be verified owing to the limitations of the number and quality of systematic review included studies.