Meta-analysis of bone morphogenetic protein versus autologous bone grafting for limb long bone nonunion
10.3969/j.issn.2095-4344.1888
- Author:
Chengxin XIE
1
Author Information
1. Graduate School of Guangxi University of Chinese Medicine
- Publication Type:Journal Article
- Keywords:
Autologous bone graft;
Bone morphogenetic protein;
Healing rate;
Infection rate;
Long bone;
Meta-analysis;
Nonunion
- From:
Chinese Journal of Tissue Engineering Research
2020;24(5):803-810
- CountryChina
- Language:Chinese
-
Abstract:
BACKGROUND: Bone morphogenetic proteins have strong bone induction properties and have been proved to promote bone healing in fracture, bone defect and other diseases. However, few studies are reported on the use of bone morphogenetic proteins in the treatment of bone nonunion, and the results of various studies remain controversial, which makes the role of bone morphogenetic proteins in the treatment of limb long bone nonunion unclear. OBJECTIVE: Meta-analysis was used to systematically evaluate the advantages and disadvantages of bone morphogenetic protein versus autogenous bone grafting in the treatment of limb long bone nonunion. METHODS: PubMed, Elsevier, Web of Science, Cochrane Library, CNKI and WanFang databases were searched to retrieve the randomized controlled trials and non-randomized controlled trials of bone morphogenetic proteins for limb long bone nonunion published before April 2019. Quality evaluation and data extraction of the included literatures were performed. Meta-analysis of outcome indicators was performed using RevMan 5. 1 software provided by Cochrane system. RESULTS AND CONCLUSION: Eight articles were enrolled, including 4 randomized controlled trials and 4 non-randomized controlled trials, all of which were small sample-size studies involving 30-124 cases. A total of 613 cases of nonunion were included. In the study group, patients received bone morphogenetic proteins or bone morphogenetic proteins in combination with bone grafting. In the control group, patients received autologous bone grafting. Meta-analysis results showed that there were no significant differences in postoperative healing rate, infection rate, secondary operation rate, and postoperative improvement in limb function between study and control groups (P > 0. 05). The mean healing time in the study group was significantly shorter than that in the control group [WMD=-1. 24, 95%C/(-1. 70,-0. 79), P< 0. 01]. Intraoperative blood loss in patients receiving simple bone morphogenetic protein was less than that in patients receiving autologous bone grafting (P < 0. 05). The hospitalization cost of bone morphogenetic protein in combination with autologous bone grafting was significantly higher than that of autologous bone grafting (P < 0. 01). There was no significant difference in hospital stay between patients receiving simple bone morphogenetic protein and patients receiving autologous bone grafting (P > 0. 05). These results suggest that bone morphogenetic protein can provide a viable alternative to autologous bone grafting, and it is also a safe adjuvant for autologous bone grafting, which has the potential advantage of accelerating fracture healing, but the current evidence does not support bone morphogenetic protein in combination with autologous bone grafting.
