低强度脉冲超声治疗骨折的系统回顾和荟萃分析

Low-intensity pulsed ultrasound in treatment of fractures:a systematic review and meta-analysis

目的:虽然许多随机试验表明低强度脉冲超声可促进骨折愈合,但因研究样本量小、统计学者主观差异等重要评价结果不一致。系统评价低强度脉冲超声治疗骨折的疗效。方法:利用PubMed、Cochrane、Library、Embase、中国知网、万方医学网、维普等数据库及人工检索南昌大学图书馆,搜索并收集采用低强度脉冲超声对骨折治疗影响的随机对照研究,时间为1999年3月至2020年3月,分别由2名评价者独立对纳入的研究进行质量评价、数据提取、相互核对,最后运用RevMan 5.3软件对相关数据进行Meta分析。结果:(1)共纳入11项随机对照试验,共1515例患者,其中试验组765例采用低强度脉冲超声治疗,对照组750例采用安慰剂或普通仪器治疗;(2)Meta分析显示,试验组骨折愈合时间短于对照组[MD=-17.92,95%CI(-28.44,-7.41),P=0.0008],两组骨折后骨不连及延迟愈合发生率、完全负重时间、返回工作时间、临床标准骨折愈合时间、上肢与下肢骨不连及延迟愈合发生率、提高生活质量、疼痛减少方面比较差异均无显著性意义(P>0.05)。结论:低强度脉冲超声可缩短骨折愈合时间。

OBJECTIVE:Although many randomized trials have shown that low-intensity pulsed ultrasound can promote fracture healing,important evaluation results such as small sample size and subjective differences of statisticians are inconsistent.This study aimed to evaluate the efficacy of low-intensity pulsed ultrasound in the treatment of fractures.METHODS:PubMed,Cochrane Library,Embase,CNKI,Wanfang Medical Network,VIP databases,and Nanchang University Library were searched to collect randomized controlled studies on the impact of low-intensity pulsed ultrasound on fracture treatment from March 1999 to March 2020.Two evaluators independently conducted quality evaluation,data extraction and cross-check on the included studies.Finally,RevMan 5.3 software was used to perform metaanalysis on the relevant data.RESULTS:(1)A total of 11 randomized controlled trials were included,including 1515 patients.The 765 patients in the trial group were treated with lowintensity pulsed ultrasound,and the 750 patients in the control group were treated with placebo or only ordinary instrument treatment group.(2)Metaanalysis showed that healing time of fracture was shorter in the trial group than that in the control group[MD=-17.92,95%CI(-28.44,-7.41),P=0.0008].There was no significant difference in incidence of nonunion and delayed union after fracture,time to return to full load,time to return to work,clinical standard fracture healing time,incidence of nonunion and delayed union of upper limb and lower limb,quality of life improvement and pain reduction(P>0.05).CONCLUSION:Low-intensity pulsed ultrasound can shorten the healing time of fracture.