自体骨移植与骨形成蛋白治疗成人长骨骨折不愈合的Meta分析

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。

Autologous bone grafting versus bone morphogenetic protein treatment for nonunion of long bone fractures in adults: a Meta analysis

Objective: To systematically evaluate the clinical effects of autologous bone grafting versus bone morphogenetic protein treatment for nonunion of long bone fractures in adults and provide reference for this fracture.Methods: According to the methods of systematic review of Cochrane,the randomized controlled trials which compared autologous bone grafting with bone morphogenetic protein treatment for nonunion of long bone fractures in adults were searched in PuMed,Embase,Cochrane library,CNKI,Wangfang data and CBM from the databases were established to March 2019. Information was screened and extracted according to the inclusion and exclusion criteria by two researchers respectively,and the qualities of the included studies were assessed by the modified Jadad quality scale. The rate of infection,successful union,second operation,hospital stays and intraoperative blood loss were compared by RevMan 5.3 software from Cochrane Collaboration for Meta-analysis.Results: Seven randomized controlled trials with a total of 652 patients were included,410 in the autologous bone grafting group and 242 in the bone morphogenetic protein group. Meta analysis showed there were no statistically significant differences regarding infectionRR=1.32,95%CI(0.90,1.93),P=0.16],successful unionRR=0.95,95%CI(0.84,1.08),P=0.43],second operationRR=1.16,95%CI(0.43,3.12),P=0.76],hospital staysMD=0.69,95%CI(-0.38,1.75),P=0.21] between the two groups. But compared with the bone morphogenetic protein treatment,autologous bone grafting significantly increased the intraoperative blood lossMD=223.00,95%CI(32.72,413.28),P=0.02].Conclusion: Since bone morphogenetic proteins can attain as the same fracture healing rate as autologous bone grafting and can significantly reduce the intraoperative blood loss,bone morphogenetic proteins may be a better choice for nonunion of long bone fractures in adults.