上颌窦底增高过程中重组人骨形成蛋白2/明胶海绵复合物诱导成骨的系统评价

A systematic review of osteogenesis induced by recombinant human bone morphogenetic protein-2/absorbable collagen sponge for maxillary sinus floor augmentation

背景:上颌后牙区由于上颌窦的存在限制了种植体的应用,骨诱导成骨技术的应用为上颌窦底的升高提供了可能和保障。虽然药理学、动物实验及部分临床研究均验证了重组人骨形成蛋白2/明胶海绵的骨诱导性,但是否存在研究的局限性、病例的自限性、结果的可靠性尚不十分清楚。目的:系统评价重组人骨形成蛋白2/明胶海绵在上颌窦底增高过程中牙槽嵴的增量疗效和安全性。方法:计算机检索PubMed(1966/2009-12)、Embase(1974/2009-12)、Cochrane Library(2009年第4期)、中国生物医学文献数据库CBM(1978/2009-12)、中国期刊全文数据库CNKI(1994/2009-12)、维普中文科技期刊数据库VIP(1989/2009-12)等数据库。主要检索词包括"rhBMP-2,ACS,autogenous bone graft;重组人骨形成蛋白2,明胶海绵,自体骨移植等"。采用自由词与主题词结合的方式检索,筛选在上颌窦底增高术中应用重组人骨形成蛋白2/明胶海绵修复的随机对照试验,应用RevMan5软件进行Meta分析。结果与结论:最终纳入3个研究,共288例患者。Meta分析结果提示,与自体骨移植组相比,1.5g/L重组人骨形成蛋白2/明胶海绵组牙槽嵴高度和宽度的增加差异有显著性意义;0.75g/L重组人骨形成蛋白2/明胶海绵组牙槽嵴高度的增加差异无显著性意义,牙槽嵴宽度的增加差异有显著性意义;重组人骨形成蛋白2/明胶海绵植入6个月后可改善种植区的骨密度,未有不良反应报道。提示1.5g/L,0.75g/L重组人骨形成蛋白2/明胶海绵及自体骨移植对骨缺损区都有明显的诱导成骨作用,1.5g/L重组人骨形成蛋白2/明胶海绵的效果优于自体骨。

BACKGROUND：Maxillary antrum limits the application of implant in maxillary molar region;the application of guided bone regeneration （GBR） provides chance and security for the elevation maxillary sinus floor.Although pharmacology,animal experiment,and some clinical research have verified the osteoinductive of recombinant human bone morphogenetic protein-2/absorbable collagen sponge （rhBMP-2/ACS）,the existence of the limitations of the study,cases of self-limiting,the reliability of the results is not very clear.OBJECTIVE：To systematically evaluate curative effect and safety of rhBMP-2/ACS on the incrementation of alveolar crest in process of maxillary sinus floor augmentation.METHODS：A computer based online search of PubMed database （1996/2009-12）,Embase database （1974/2009-12）,Cochrane Library database （the 4th period,2009）,CBM database （1978/2009-12）,and CNKI database （1994/2009-12）,VIP database （1989/2009-12） was performed with the key words ＂rhBMP-2,ACS,autogenous bone graft＂ in English,and ＂rhBMP-2,ACS,autogenous bone graft＂ in Chinese.The literatures were retrieved by the way of free words combined with key words.The studies of randomized controlled trials （RCTs） which addressed the efficiency of rhBMP-2/ACS compared with an autogenous bone graft were selected and reviewed.And RevMan 5 software was used for Meta-analysis.RESULTS AND CONCLUSION：Three RCTs was finally included,a total of 288 patients.Meta-analysis results showed that there was significant difference between 1.5 g/L rhBMP-2/ACS and autogenous bone graft in height changes and width changes of alveolar ridge.While for 0.75 g/L rhBMP-2/ACS group,there was no significant difference in height changes of alveolar ridge.There was significant difference in width changes of alveolar ridge.After 6 months rhBMP-2/ACS,the bone density can be improved in implant region,no reports of untoward reaction.1.5 g/L rhBMP-2/ACS,0.75 g/L rhBMP-2/ACS and autogenous bone graft had good effects for the bone induction,and the effect of rhBMP-2/ACS was superior to autogenous bone.