摘要
目的采用Meta分析的方法评价富血小板血浆(platelet rich plasma,PRP)联合植骨内固定治疗骨不连的临床疗效。方法系统检索PubMed、Ovid Embase、The Cochrane Library、中国知网、万方、维普、中国生物医学文献数据库中PRP联合植骨内固定与植骨内固定比较治疗骨不连的随机对照试验(randomized controlled trial,RCT),检索时限为建库至2023年10月9日。对纳入研究提取资料并进行质量评价,采用RevMan 5.3软件和R 4.3.1软件进行统计分析。结果共纳入10个RCT,包括骨不连患者522例,其中PRP联合治疗组260例、植骨内固定组262例,总体为中等质量。Meta分析结果显示,与植骨内固定组比较,PRP联合治疗组可增加骨不连愈合率[OR=3.73,95%CI(2.04,6.85),P<0.001],缩短骨不连临床愈合时间[SMD=-2.38,95%CI(-2.79,-1.98),P<0.001]和骨性愈合时间[SMD=-1.76,95%CI(-2.35,-1.16),P<0.001)],提高骨痂X线评分[MD=0.86,95%CI(0.47,1.25),P<0.001],降低治疗过程中并发症发生率[OR=0.32,95%CI(0.18,0.55),P<0.001]。两组在住院时间[MD=-3.08,95%CI(-6.99,0.83),P=0.12]和肢体功能优良率[OR=1.91,95%CI(0.90,4.05),P=0.09]方面的差异无统计学意义。结论PRP联合植骨内固定治疗骨不连是一种安全有效的方法,可增加骨不连愈合率,缩短愈合时间,降低并发症发生率。受样本量的影响,上述结论尚待更多高质量临床RCT加以证实。
Objective To detect the clinical effects of platelet rich plasma(PRP)combined with bone graft and internal fixation for bone nonunion by conducting Meta-analysis.Methods PubMed,Ovid Embase,The Cochrane Library,CNKI,WanFang Data,VIP,and CBM were electronically searched to collect randomized controlled trials(RCTs)of PRP for bone nonunion from inception to October 9,2023.The data of included studies was extracted and the risk of bias was assessed,and a Meta-analysis was performed by using RevMan 5.3 and R 4.3.1 software.Results Ten moderate-quality RCTs involving 522 bone nonunion patients(260 in PRP combined group,and 262 in bone graft and internal fixation group)were included.The results of Meta-analysis showed that compared with the bone graft and internal fixation group,PRP combined with bone graft and internal fixation could significantly increase the nonunion healing rate[OR=3.73,95%CI(2.04,6.85),P<0.001],decrease the fracture clinical healing time[SMD=-2.38,95%CI(-2.79,-1.98),P<0.001]and bone healing time[SMD=-1.76,95%CI(-2.35,-1.16),P<0.001],improve the scores of X-ray[MD=0.86,95%CI(0.47,1.25),P<0.001],decrease the incidence of complications[OR=0.32,95%CI(0.18,0.55),P<0.001],while there were no significant difference in hospital stays[MD=-3.08,95%CI(-6.99,0.83),P=0.12]and the limb function[OR=1.91,95%CI(0.90,4.05),P=0.09].Conclusion PRP combined with bone graft and internal fixation may be an effective and safe therapeutic method for nonunion,which could increase the nonunion healing rate,decrease the healing time and the incidence of complications.Due to sample-size of the study,more high-quality RCTs are need to verify the above conclusion.
作者
何仁姣
王君
裴斌
黄国鑫
田建洲
刘盈
闫柳
艾金伟
HE Renjiao;WANG Jun;PEI Bin;HUANG Guoxin;TIAN Jianzhou;LIU Ying;YAN Liu;AI Jinwei(The Third Department of Orthopedics/Department of Plastic Surgery,Xiangyang No.1 People’s Hospital Affiliated to Hubei University of Medicine,Xiangyang 441000,Hubei Province,China;Evidence-Based Medicine Center,Xiangyang No.1 People’s Hospital Affiliated to Hubei University of Medicine,Xiangyang 441000,Hubei Province,China;Department of Cardiovascular Medicine,Xiangyang No.1 People’s Hospital Affiliated to HubeiUniversity of Medicine,Xiangyang 441000,Hubei Province,China;Department of Plastic Surgery and Regenerative Medicine,Fujian Medical University Union Hospital,Fuzhou 350001,China)
出处
《数理医药学杂志》
CAS
2024年第4期276-286,共11页
Journal of Mathematical Medicine
基金
湖北省“323”攻坚行动襄阳市第一人民医院重点专项科研基金项目(XYY2022-323)。
关键词
骨不连
富血小板血浆
植骨
内固定
META分析
Bone nonunion
Platelet rich plasma
Bone graft
Internal fixation
Metaanalysis
