Kümmell病的临床治疗进展

目的:系统评价自体骨移植与骨形成蛋白治疗成人长骨骨折不愈合相关指标,为成人长骨骨折不愈合治疗提供参考依据。方法:计算机检索PuMed、Embase、Cochrane图书馆、中国知网(CNKI)、万方数据期刊全文数据库及中国生物医学文献数据库(CBM)发表的对于自体骨移植与骨形成蛋白治疗成人长骨骨折不愈合的随机对照试验,检索时间从建库至2019年3月。由2名研究者按照纳入和排除标准独立进行筛选文献,提取资料,并采用Jadad评价量表对纳入的文献进行质量评价。采用RevMan 5.3统计学软件对两种方法的感染发生率、成功愈合率、二次手术率、住院时间及术中失血量进行Meta分析。结果:共纳入7个随机对照试验研究,共652例患者,自体骨移植组有410例,骨形成蛋白组有242例。Meta分析结果显示:自体骨移植组与骨形成蛋白组在感染发生率RR=1.32,95%CI(0.90,1.93),P=0.16],成功愈合率RR=0.95,95%CI(0.84,1.08),P=0.43],二次手术率RR=1.16,95%CI(0.43,3.12),P=0.76]及住院时间MD=0.69,95%CI(-0.38,1.75),P=0.21]方面比较差异无统计学意义。自体骨移植组术中失血量明显高于骨形成蛋白组MD=223.00,95%CI(32.72,413.28),P=0.02]。结论:对于成人长骨骨折不愈合的治疗,骨形成蛋白可以获得和自体骨移植一样的骨折愈合率,同时可以明显减少术中失血量。骨形成蛋白可能更适合成人长骨骨折不愈合的治疗。

Progress on clinical treatment of Kümmell's disease

Kümmell''s disease is a delayed complication of osteoporotic vertebral compression fracture (OVCF). The disease can occur months or even years after the initial spinal injury. Unlike the common osteoporotic compression fracture,it develops slowly and causes intractable pain or neurological dysfunction due to intraspinal instability. So far,the pathogenesis of Kümmell''s disease has not been completely clear,there is no standard treatment or single effective treatment for Kümmell''s disease. The effect of conservative treatment is often not good. Minimally invasive treatment has become the main treatment for patients with Kümmell''s disease due to its short operation time,small trauma and exact effect. However,there are complications such as leakage of bone cement and delayed displacement of bone cement. Moreover,minimally invasive treatment is not suitable for all types of Kümmell''s disease patients. Patients with posterior cortical fracture and spinal cord compression need to be opened Radiotherapy,whether anterior or posterior,has the disadvantages of long operation time,large trauma and high treatment cost. This article reviews the progress in the treatment of Kümmell''s disease to provide guidance for clinical treatment.