Masquelet技术治疗感染性骨不连疗效的Meta分析

Masquelet technique in treatment of infectious nonunion:a meta-analysis

目的:目前已有大量临床研究结果证实masquelet技术治疗感染性骨不连疗效确切且安全性高,但绝大部分研究属于回顾性病例分析,样本量较小,尚缺乏充足的循证学证据。文章对Masquelet技术治疗感染性骨不连的有效性和安全性进行Meta分析。方法:应用计算机全面检索PubMed、Embase、The Cochrane Libraray、Web of Science和中国生物医学文献数据库(CBM)、中国知网、万方和维普数据库建库至2020年5月发表的关于masquelet技术治疗感染性骨不连的随机或非随机对照试验,根据纳入和排除标准对文献进行筛选、数据提取、质量评价后,使用RevMan 5.3软件对结局指标进行Meta分析。结果:①共纳入12篇文献,均为非随机对照试验,根据MINORS评分量表,其中有5篇为高质量文献、7篇为中质量文献;②Meta分析显示:与Ilizarov组相比,Masquelet组在术后平均愈合时间(MD=-9.80,95%CI:-14.17至-5.43)、并发症发生率(RR=0.44,95%CI:0.35-0.55)和医疗费用(MD=-0.70,95%CI:-1.13至-0.28)方面差异有显著性意义(P<0.05),而在临床疗效优良率、患肢功能优良率和手术次数方面比较差异无显著性意义(P>0.05);③与Ⅰ期植骨组相比,Masquelet组在骨愈合率(RR=1.37,95%CI:1.15-1.62,P=0.0004)差异有显著性意义(P<0.05),在并发症发生率、感染控制率等方面比较差异无显著性意义(P>0.05)。结论:Masquelet技术与Ilizarov技术治疗感染性骨不连均能取得良好疗效,但Masquelet技术较Ilizarov技术具有并发症少、愈合时间短和费用低等优点,另外在骨愈合率方面也优于Ⅰ期植骨,因此Masquelet技术是一种疗效可靠、安全性较高的感染性骨不连治疗方法,但此结论需更多高质量、多中心、大样本的随机对照试验进一步证实。

OBJECTIVE:At present,a large number of clinical studies have confirmed that Masquelet technology is effective and safe in the treatment of infectious bone nonunion,but most studies belong to retrospective case analysis,and the sample size is small,and there is still insufficient evidence-based evidence.Metaanalysis in the effectiveness and safety of Masquelet technique in treating infectious nonunion was conducted.METHODS:A computer was used to comprehensively search PubMed,Embase,The Cochrane Libraray,Web of Science and China Biology Medicine Database,CNKI,Wanfang,and VIP databases for randomized or non-randomized controlled trials of Masquelet technique in the treatment of infectious nonunion published from inception to May to 2020.After literature screening,data extraction,and quality evaluation according to inclusion and exclusion criteria,RevMan 5.3 software was used to perform meta-analysis of outcome indicators.RESULTS:(1)A total of 12 articles were included,all of which were non-randomized controlled studies.According to the MINORS scoring scale,five articles were high-quality articles and seven articles were medium-quality articles.(2)Meta-analysis showed that:compared with Ilizarov group,average postoperative healing time(MD=-9.80,95%CI:-14.17 to-5.43),complication rate(RR=0.44,95%CI:0.35-0.55),and medical expenses(MD=-0.70,95%CI:-1.13 to-0.28)were statistically significant in the Masquelet group(P<0.05).However,excellent and good rate of clinical efficacy,excellent and good rate of affected limb function,and number of operations were not statistically significant between the two groups(P>0.05).(3)Compared with the stage I bone graft group,the Masquelet group had a significant difference in the bone healing rate(RR=1.37,95%CI:1.15-1.62,P=0.0004)(P<0.05),but complication rate and infection control rate were not statistically significant between them(P>0.05).CONCLUSION:Both Masquelet technique and Ilizarov technique can achieve good curative effect in the treatment of infectious bone nonunion.However,compared with Ilizarov technique,Masquelet technique has the advantages of fewer complications,shorter healing time and lower cost,and the bone healing rate is better than the first-stage bone graft.Thus,Masquelet technology is a reliable and safe treatment for infectious nonunion,but this conclusion needs more high-quality,multi-center,large-sample randomized controlled studies to further confirm.