【罂粟摘要】胫骨平台骨折手术中自体骨移植与合成骨移植效果比较：随机对照试验的系统回顾和Meta分析

胫骨平台骨折手术中自体骨移植与合成骨移植效果比较：随机对照试验的系统回顾和Meta分析

贵州医科大学     麻醉与心脏电生理课题组

翻译：柏雪  编辑：陈锐  审核：曹莹

罂 粟 摘 要  

摘要

目的：我们目的是进行系统回顾和Meta分析，以确定胫骨平台骨折手术治疗中自体骨移植和合成骨移植的临床结果是否存在差异。

方法：从试验开始到2021 年7月28日，对MEDLINE、EMBASE、骨与关节出版在线档案和中央数据库进行结构化搜索，包括比较胫骨平台骨折中自体骨移植和合成骨移植的随机对照临床试验。排除了临床前研究、儿科患者临床研究、病理性骨折、骨折不愈合或软骨缺损。获得的结果数据采用偏倚风险2（ROB2）框架进行评估，并在随机效应Meta分析中进行综合。在整个过程中，遵循了系统评价和Meta分析指南的首选报告项目。

结果：从3078份记录中识别出6项研究(涉及353处骨折)。ROB2评估后，五项研究（代表338处骨折）适合进行Meta分析。主要结果显示，在人工骨移植术后即刻（平均差-0.45 mm，p=0.25，95%置信区间（CI）-1.21 to 0.31, I2=0%）和长期（超过6个月，标准平均差-1.56，p=1.09，95%CI-1.20 to 0.08，I2=73%）随访中，关节凹陷无明显减少。次要结果包括长期随访时的机械对齐、肢体功能和缺损部位疼痛、围手术期失血、手术持续时间、手术部位感染的发生和二次手术。综合治疗组的平均失血量较低（90.08ml，p<0.001，95%可信区间41.49 to 138.67），手术时间较短（16.17 minutes，p=0.04，95%置信区间0.39 to 31.94）。所有其他次要指标在统计上具有可比性。

结论：所有研究报告了相似的方法和患者群体；然而，性能变化可能会导致不精确性。这些发现取代了以往的文献，表明尽管自体骨移植具有明显的生物学优势，但它并不能证明其优于人工骨移植。在选择填塞物时，外科医生应考虑患者的其他疾病、环境和社会因素，以及围手术期和术后护理。

原始文献来源：G. M. Cooper , M. J. Kennedy, B. Jamal,et,al.Autologous versus synthetic bone grafts for the surgical management of tibial plateau fractures: a systematic review and meta- analysis of randomized controlled trials. Bone Jt Open 2022;3-3:218–228.

 英文原文 

Autologous versus synthetic bone grafts for the surgical management of tibial plateau fractures: a systematic review and meta- analysis of randomized controlled trials

Aims

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.

Methods

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.

Results 

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. I2 = 0%) and long- term (> six months, standard mean difference -0.56, p = 0.09, 95% CI -1.20 to 0.08, I2 = 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.

Conclusion

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.

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