骨形态生成蛋白治疗骨折的系统评价

Bone morphogenetic protein for the treatment of fracture:a systematic review

[目的]系统评价骨形态生成蛋白对骨折治疗的有效性和安全性。[方法]按照Cochrane协作网制订的检索策略进行检索,计算机检索MEDLINE(1966～2010年6月)、EMBASE(1974～2010年6月)、Cochrane图书馆(2010年第6期)、中国生物医学文献数据库(CBM,1978～2010年6月)、中国期刊全文数据库(CNKI,1994～2010年6月)、中文科技期刊全文数据库(VIP,1989～2010年6月)及万方数据库(1979～2010年6月)。手工检索相关的中英文骨科杂志和会议论文。纳入骨形态生成蛋白治疗骨折的所有随机对照试验,由两名评价员独立提取资料,并对其方法学质量进行评价。对符合纳入标准的研究用RevMan5.0软件进行Meta分析。[结果]共纳入8个随机对照试验。643例患者。Meta分析结果显示:骨形态生成蛋白(BMP)可以提高治疗急性骨折的愈合率[RR=1.40,95%CI(1.10,1.79)P=0.007],但不能提高骨折不愈合的愈合率[RR=1.09,95%CI(0.93,1.27)P=0.27];另外,应用BMP治疗骨折后发生疼痛的不良反应减少[RR=0.85,95%CI(0.74,0.99)P=0.03],但对感染没有作用[RR=0.96,95%CI(0.68,1.36)P=0.83]。[结论]骨形态生成蛋白(BMP)可以提高急性骨折的愈合率并减少疼痛不良反应的发生。但限于纳入研究在方法学方面的局限性,尚需开展大样本、高质量的RCT进一步论证其疗效和安全性。

[Objective]To assess the efficacy and safety of bone morphogenetic protein（BMP） for fractures.[Methods]The author searched the Cochrane Central Register of Controlled Trials（CENTRAL）（Issue 3,2010）,MEDLINE,EMBASE,CBM,CNKI,VIP,Wanfang database,etc.from their inception to June 2010.Some relevant journals were handsearched as well.Two reviewers independently evaluated the quality of the included studies and extracted the data.Meta-analysis was performed by RevMan5.0 software.[Results]Eight randomized controlled trials（RCTs） involving 643 patients were included.BMP can increase the union rate of acute fractures,but failed to improve the union rate of nonunion fractures.Additionally,BMP reduces the incidence of pain after fracture.However,there is no effect on infection.[Conclusion]BMP increases the union rate of acute fractures and reduces the incidence of adverse reactions of pain.There is a moderate possibility of selection bias,performance bias and publication bias in this review because of small number of the included studies,which weakens the evidence of the results.More large sample size,high-quality RCTs are needed.