基于PRISMA原则的对比Masquelet技术与骨搬运修复下肢大段骨缺损疗效的meta分析

A meta-analysis of Masquelet technique versus bone transport in lower extremity bone defect reconstruction

目的通过Meta分析评价Masquelet技术与骨搬运技术修复下肢骨缺损的疗效差异。方法检索Pubmed、Embase、CNKI、万方、CBM数据库,收集1950年1月至2019年10月国内外正式刊物发表的有关Masquelet技术与骨搬运技术治疗下肢骨缺损病例对照研究的中英文文献,严格评价纳入研究的文献质量,提取相关资料,运用RevMan5.3软件统计分析数据。结果共纳入7项研究,包含325名患者。资料分析显示,在Paley骨愈合优良率(RR=0.99,95%CI:0.85,1.15,P=0.93)、肢体功能优良率(RR=1.23,95%CI:0.90,1.67,P=0.19)、Iowa膝关节评分(SMD=0.45,95%CI:-0.05,0.94,P=0.08)、Iowa踝关节评分(SMD=0.10,95%CI:-0.39,0.59,P=0.69)等方面,Masquelet组与骨搬运组无显著性差异。与骨搬运组相比,Masquelet组并发症发生率较低(RR=0.55,95%CI:0.38,0.79,P=0.001),感染控制率较高(RR=1.15,95%CI:1.03,1.30,P=0.02),手术次数较少(SMD=-0.47,95%CI:-0.81,-0.14,P=0.005),治愈时间较短(SMD=-1.19,95%CI:-2.15:-0.22:P=0.02),术后SF-36评分较高(SMD=2.33,95%CI:1.81,2.85,P<0.01)。结论与骨搬运技术相比,Masquelet技术修复下肢大段骨缺损在并发症发生率、感染控制率、手术次数、治愈时间、术后SF-36评分方面可能更有优势,而在Paley骨愈合优良率、肢体功能优良率、Iowa膝踝关节评分方面两者并无差异。有待多中心、高质量、长期随访的研究进一步评估。

Objective To compare the efficacy and safety between Masquelet technique and bone transport in lower extremity bone defect reconstruction.Methods PubMed,EMBASE,CNKI,Wanfang,CBM and Weipu databases were searched.Chinese and English literatures on Masquelet technique and bone transport in the treatment of lower limb bone defect published in official journals from January 1950 to October 2019 were collected.The quality of the included literatures was strictly evaluated,and relevant data were extracted.The data were statistically analyzed by RevMan 5.3 software.Results A total of seven studies involving 325 patients were included.There were no significant difference in Paley bone healing(RR=0.99,95%CI:0.85,1.15,P=0.93),the rate of good and excellent limb function(RR=1.23,95%CI:0.90,1.67,P=0.19),the Iowa knee score(SMD=0.45,95%CI:-0.05,0.94,P=0.08),and the Iowa ankle score(SMD=0.10,95%CI:-0.39,0.59,P=0.69)between the Masquelet group and bone transport group.Compared with the bone transport group,there was a lower incidence of complications(RR=0.55,95%CI:0.38,0.79,P=0.001),a higher infection control rate(RR=1.15,95%CI:1.03,1.30,P=0.02),fewer surgeries(SMD=-0.47,95%CI:-0.81,-0.14,P=0.005),and a shorter healing time(SMD=-1.19,95%CI:2.15,0.22,P=0.02),higher postoperative SF-36 score(SMD=2.33,95%CI:1.81,2.85,P<0.01)in the Masquelet group.Conclusions Compared with bone transport technique,Masquelet technique may have more advantages in the incidence of complications,infection control rate,number of surgeries,healing time,and postoperative SF-36 score in repairing of bone defects of lower extremity.However,there is no difference in Paley bone healing score,limb function score,Iowa knee and ankle joint score.Further research is required and future studies should include assessments of outcome at long-term follow-up.