Recombinant human BMP-2 for the treatment of open tibial fractures.
Recombinant human BMP-2 for the treatment of open tibial fractures.
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DOI：
10.3928/01477447-20120525-23
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发表时间：
2012-06
期刊：
影响因子：
1.1
通讯作者：
Shijun Wei;Xianhua Cai;Ji-feng Huang;Feng Xu;Ximing Liu;Qing Wang
中科院分区：
文献类型：
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作者：
Shijun Wei;Xianhua Cai;Ji-feng Huang;Feng Xu;Ximing Liu;Qing Wang
重组人骨形态发生蛋白-2（rhBMP-2）促进开放性胫骨骨折髓内钉内固定的愈合。但是，尚未进行常规使用。本研究的目的是对使用rhBMP-2治疗髓内钉固定治疗的急性开放性胫骨骨折的文献进行系统综述，并对随机对照试验进行荟萃分析。检索了多个数据库、相关文献的参考文献列表和主要骨科期刊。对基本信息和主要结果进行了比较。纳入了4项研究，共609例患者，标准治疗（SOC）组的二次干预率显著高于rhBMP-2联合可吸收胶原海绵（rhBMP-2/ACS）组（分别为27.1%和17.5%; P<0.01）。SOC组的治疗失败率显著更高（分别为34.3%和21.4%; P<0.01）。感染率、内固定失效率、20周骨折愈合率和术后疼痛水平无显著差异。对于接受扩髓髓内钉固定治疗的患者，仅SOC组的治疗失败率显著较高（分别为21.5% vs 14.2%; P= 0.02）;未观察到其他显著差异。在Gustilo-Anderson Ⅲ A级和B级开放性胫骨骨折的治疗中加入rhBMP-2，每例患者可净节省约6000美元，在开放性胫骨骨折髓内钉固定中加入重组人骨形态发生蛋白-2可减少二次干预的频率和总的医疗费用。对于扩髓患者，添加rhBMP-2减少了治疗失败。该分析支持rhBMP-2/ACS治疗这些严重骨折的临床疗效。
Recombinant human bone morphogenetic protein-2 (rhBMP-2) improves healing of open tibial fractures treated with intramedullary nail fixation. However, routine use has not occurred. The purposes of the current study were to provide a systematic review of the literature using rhBMP-2 in the treatment of acute open tibial fractures treated with intramedullary nail fixation and to provide a meta-analysis of the randomized, controlled trials. Multiple databases, reference lists of relative articles, and main orthopedic journals were searched. The basic information and major results were compared. Four studies with a total of 609 patients were included.The secondary intervention rate in the standard-of-care (SOC) group was significantly higher than in the rhBMP-2 combined with absorbable collagen sponge (rhBMP-2/ACS) group (27.1% vs 17.5%, respectively; P<.01). The treatment failure rate in the SOC group was significantly higher (34.3% vs. 21.4%, respectively; P<.01). No significant differences were found in infection rate, hardware failure rate, fracture healing rate at 20 weeks, and postoperative pain level. For patients treated with reamed intramedullary nail fixation, only the treatment failure rate in the SOC group was significantly higher (21.5% vs 14.2%, respectively; P=.02); no other significant difference was observed. Adding rhBMP-2 to the treatment of Gustilo-Anderson grade IIIA and B open tibial fractures led to net savings of approximately $6000 per case.Recombinant human bone morphogenetic protein-2 added to intramedullary nail fixation of open tibial fractures could reduce the frequency of secondary interventions and total health care costs. For reamed patients, adding rhBMP-2 reduced treatment failure. This analysis supports the clinical efficacy of rhBMP-2/ACS for the treatment of these severe fractures.