自体髂骨植骨供骨区并发症的Meta分析

背景：目前,自体髂骨移植被广泛认为是治疗骨缺损的＂金标准＂;然而,髂嵴供骨区常出现并发症,限制了其在临床上的推广使用。目的：采用循证医学研究方法,对已发表相关文献进行汇总分析,总结自体髂骨植骨后供骨区并发症的种类及发生率。方法：检索Pub Med Medline、Ovid Medline、Cochrane Database、Embase Database等数据库,检索时间范围：2002年1月至2011年12月,以＂Iliac crest bone graft＂或＂autologous bone graft＂或＂bone graft donor site＂或＂complication＂或＂Morbidity＂为检索词,共检索到174篇文献。根据检索条件及评价标准,最终筛选出30篇临床研究报道进行Meta分析,共计2476例患者。采用SPSS13.0和R软件及其Meta程序包对检索结果进行统计分析。结果与结论：自体髂骨植骨后供骨区主要并发症包括供骨区≥6个月长期疼痛（发生率=7.88%,95%可信区间4.76%-12.79%）、供骨区感染（发生率=4.26%,95%可信区间2.95%-6.12%）、血肿及血清肿（发生率=6.55%,95%可信区间4.90%-8.70%）、神经损伤（发生率=5.85%,95%可信区间3.46%-9.71%）、感觉障碍（发生率=10.1%,95%可信区间6.07%-16.23%）。可见髂骨取骨后并发症发生率较高,临床医师应予以重视。

Meta-analysis of complications following autologous iliac crest bone graft from donor site

BACKGROUND： Recently, autologous iliac crest bone graft is considered to be the ＂gold standard＂ therapeutic method for bone defects. However, there are some complications in iliae crest bone donor site, and the clinical application is limited. OBJECTIVE： To compiled analyze the published articles and evaluate the types of complications and morbidity following autologous iliac crest bone graft by employing evidence-based medicine method. METHODS： A computer-based online search in PubMed Medline database, Ovid Medline database, Cochrane database and Embase database was performed using key words of ＂Iliac crest bone graft＂, ＂autologous bone graft＂, ＂bone graft donor site＂, ＂complication＂ or ＂morbidity＂ in English. The published dates were limited between January 2002 and December 2011. A total of 174 articles were searched. Then 30 articles, involving 2476 patients, were selected for the clinical Meta analysis according to retrieval conditions and inclusion criteria. All relevant data were extracted and analyzed using SPSS 13.0 and R software and its Meta package. RESULTS AND CONCLUSION： The result indicated that the complications of autologous iliac crest bone graft in donor site included chronic pain （≥6 months） [incidence rates=7.88%,95% confidence interval （CI） 4.76-12.79], infection（incidence rate=4.26%, 95% CI 2.95-6.12]）, hematoma or seroma （incidence rate=6.55%, 95% CI 4.90-8.70）, nerve injury （incidence rates=5.85%, 95% CI 3.46-9.71）, sensory disturbance （incidence rate=10.1%, 95% CI 6.07-16.23） respectively. The postoperative complications of autologous iliac crest bone graft are common; therefore, it should be emphasized by clinicians.