富血小板血浆联合植骨治疗骨不连疗效的Meta分析

Meta-analysis of effects of platelet rich plasma along with autologous bone graft on bone nonunion

目的通过Meta分析评价富血小板血浆(PRP)治疗骨不连的效果。方法通过检索CNKI、Pubmed、Embase数据库及Cochrane图书馆中比较是否使用PRP治疗骨不连的临床效果的随机对照实验和回顾性队列研究文献,并追查已纳入文献的参考文献,由2位评价员做独立的文献筛查、资料提取和质量评价,并交叉核对,出现不同意见时咨询第三方。所得数据通过Rev Man 5.2统计软件完成Meta分析,对数据进行异质性分析,用Meta分析方法对数据进行处理,评估其加权均数差(WMD)、比值比(OR)、95%可信区间(CI),比较PRP+植骨与单纯植骨的愈合率、愈合时间、X线骨痂量。结果本研究共纳入了5篇文献中的287例骨不连的患者。结果显示PRP联合植骨的愈合成功率更高[OR=2.93,95%CI(1.46,5.91),P<0.01],愈合时间更快[WND=-2.05,95%CI(-3.99,-0.11),P<0.01],组间差异具有统计学意义;但是X线骨痂量的改变,组间差异无统计学意义[WND=0.41,95%CI(-0.53,1.35),P>0.05]。结论在治疗骨不连时,富血小板联合植骨可以提高骨不连的愈合成功率、缩短骨不连的愈合时间。但目前尚无足够证据证明PRP可以增加骨痂的生成,对于PRP治疗骨不连的长期疗效有待更进一步的研究。

Objective To compare the effects of platelet rich plasma along with autologous bone graft on the healing rate of bone nonunion. Methods PubMed, Embase, CNKI and the Cochrane Library were comprehensively searched and a systematic review and cumulative meta-analysis of all the randomized controlled trials （RCTs） and retrospective comparative studies was performed. Methodological quality of the trials was critically assessed, and the relevant data were extracted. Statistical software Revman 5.2 was used for data-analysis and the data was dealt by meta-analysis. The odds ratio （OR）, weighted mean defference （WMD） and 95% confidence interval （CI） were calculated. Results Five trials involving 287 patients were identified as meeting all the eligibility criteria. The results showed that PRP along with autologous bone graft in the treatment of bone nonunion significantly decreased the healing duration [ OR = 2. 93, 95% CI（ 1.46,5.91 ）, P 〈 0. 01 ], increased the curative rate [ WMD = - 2. 05, 95% CI（ - 3.99, - 0. 11 ）, P 〈 0. 01 ], but the two groups had no statistical difference in the amount of callus of X-ray [WMD=0.41, 95%CI（-0.53,1.35）, P 〉0.05]. Conclusion Application of PRP along with autologous bone graft in the site of non-union of long bone results in higher curative rate, shorter healingduration, but there is not enough evidence to show any statistical difference PRP in regards to the amount of callus of X-ray after the surgery.