[1]华堃池,冯江涛,杨雄刚,等.脱钙骨基质在四肢植骨中应用的有效性及安全性的系统评价与Meta分析[J].中华老年骨科与康复电子杂志,2018,(04):235-246.[doi:10.3877/cma.j.issn.2096-0263.2018.04.009]
　Hua Kunchi,Feng Jiangtao,Yang Xionggang,et al.The effectiveness and safety of demineralized bone matrix in limbs bone grafting: a systemicreview and meta-analysis[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2018,(04):235-246.[doi:10.3877/cma.j.issn.2096-0263.2018.04.009]
点击复制

脱钙骨基质在四肢植骨中应用的有效性及安全性的系统评价与Meta分析()
分享到：

中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2018年04期
页码:
235-246
栏目:
Meta分析
出版日期:
2018-07-30

文章信息/Info

Title:
The effectiveness and safety of demineralized bone matrix in limbs bone grafting: a systemicreview and meta-analysis
作者:
华堃池1; 冯江涛1; 杨雄刚1; 伦登兴2; 王丰1; 刘永恒1; 杨立1; 张浩1; 胡永成3
300070 天津医科大学研究生院1；261000 潍坊市人民医院脊柱外科2；300211 天津市天津医院骨肿瘤科3
Author(s):
Hua Kunchi1;  Feng Jiangtao1;  Yang Xionggang1;  Lun Dengxing2;  Wang Feng1;  Liu Yongheng1;  Yang Li1;  Zhang Hao1;  Hu Yongcheng3.
1Tianjin Medical University, Tianjin 300070, China; 2Department of Spine Surgery, Weifang People’s Hospital, Weifang 261000, China; 3Department of Bone Oncology, Tianjin Hospital, Tianjin 300211, China
关键词:
脱钙骨基质;  骨移植;  Meta分析
Keywords:
Demineralized bone matrix;  Bone transplanation;  Meta-analysis
DOI:
10.3877/cma.j.issn.2096-0263.2018.04.009
文献标志码:
A
摘要:
目的 研究脱钙骨基质（DBM）在四肢植骨手术中的疗效，对所有已获得的数据进行系统综述和Meta分析，评价DBM在四肢植骨手术中作为骨移植替代物的有效性及安全性。方法 在PubMed、MEDLINE，EMBASE和Cochrane协作网图书馆中进行文献检索。检索DBM在四肢植骨手术中的应用，根据文献纳入标准进行选择。重点选择数据可以被提取以及能够进行Meta分析的文章。结果 44项研究符合纳入标准，其中随机对照试验3篇，病例系列研究27篇，病例-对照研究14篇。所有的研究报告均未报道DBM作为移植物，融合部位出现破坏或者移位。结论 1项病例系列研究认为，使用Allomatrix DBM作为自体骨移植的替代品，其极高的并发症风险是不可接受的。余下43项研究报告得出的结果均为DBM与自体骨和其他骨移植替代材料相比较具有非劣效性，根据患者的随访报告结果可以认为DBM作为骨移植替代材料的融合率和安全性是有保障的，但是这方面证据的数量和质量是非常有限的。
Abstract:
Objective To study the efficacy of decalcified bone matrix (DBM ) in limb bone grafting surgery. A systematic review and meta-analysis of all available data was conducted to evaluate the effectiveness and safety of DBM as a bone graft substitute in limb limb grafting. Methods Literature research was performed in the PubMed, MEDLINE, EMBASE and the Cochrane Library. The application of DBM in bone grafting of limbs was retrieved and selected according to the literature inclusion criteria. Focus on selecting articles that can be extracted and meta-analyzed. Results Forty-four studies met the inclusion criteria, including three randomized controlled trials, 27 case series studies, and 14 case-control studies. None of the studies reported the destruction or displacement of DBM as a fusion site of the graft. Conclusions A series of case studies suggest that the use of Allomatrix DBM as a surrogate for autologous bone grafts has an unacceptably high risk of complications. The results of the remaining 43 studies reported that DBM was non-inferior compared to autologous bone and other bone graft substitute materials. According to the follow-up report of patients, the fusion rate and safety of DBM as a substitute material for bone graft can be considered. It is guaranteed, but the amount and quality of evidence in this area is very limited.

参考文献/References:

1 张永光, 王志强. 骨移植替代材料研究进展 [J]. 中国修复重建外科杂志, 2008, 22(10): 1264-1268.
2 Hsu W, Fuchs D, Anderson P. A Meta-Analysis of fusion rates from bone graft substitutes in a rodent posterolateral spine arthrodesis model [J]. Spine J, 2011, 11(10): 59-60.
3 Zou SS, Chen TT, Tian RH. Meta-analysis of complications following autologous iliac crest bone graft from donor site [J]. Chin J Tissue Eng Res, 2013 (5): 65-66.
4 Urist MR. Bone: formation by autoinduction [J]. Science, 1965, 150(3698): 893-899.
5 Ziran BH, Smith WR, Morgan SJ. Use of calcium-based demineralized bone matrix/allograft for nonunions and posttraumatic Reconstruction of the appendicular skeleton: Preliminary results and complications [J]. J Trauma, 2007, 63(6): 1324-1328.
6 Whiteman DT, Monk P. Demineralized bone powder clinical applications for bone defects of the hand [J]. J Hand Surg Br, 1993, 18(4): 487-490.
7 Tiedeman JJ, Garvin KL, Kile T, et al. The role of a composite demineralized bone matrix and bone marrow in the treatment of osseous defects [J]. Orthopedics, 1995, 18(12): 1153-1158.
8 Crosby LA, Yee TC, Formanek TS, et al. Complications following arthroscopic ankle arthrodesis [J]. Foot Ankle Int, 1996, 17(6): 340-342.
9 Rougraff BT, Kling TJ. Treatment of active unicameral bone cysts with percutaneous injection of demineralized bone matrix and autogenous bone marrow [J]. J Bone Joint Surg Am, 2002, 84(6): 921-929.
10 Neel M. The use of a periosteal replacement membrane for bone graft containment at allograft-host junctions after tumor resection and Reconstruction with bulk allograft [J]. Orthopedics, 2003, 26(5, S): S587-S589.
11 Wilkins RM, Kelly CM. The effect of AlloMatrix Injectable Putty on the outcome of long bone applications [J]. Orthopedics, 2003, 26(5, S): S567-S570.
12 Wilkins RM, Chimenti BT, Rifkin RM. Percutaneous treatment of long bone nonunions: the use of autologous bone marrow and allograft bone matrix [J]. Orthopedics, 2003, 26(5 Suppl): s549-s554.
13 Kelly CM, Wilkins RM. Treatment of benign bone lesions with an injectable Calcium sulfate-based bone graft substitute [J]. Orthopedics, 2004, 27(1, S): S131-S135.
14 Etienne G. Ragland PS,Mont Ma.use of cancellous bone chips and demineralized bone matrix in the treatment of acetabular osteolysis:preliminary 2-year follow-up [J]. Orthopedics, 2004, 27(1 Suppl): 123-126.
15 Kanellopoulos AD, Yiannakopoulos CK, Soucacos PN. Percutaneous reaming of simple bone cysts in children followed by injection of demineralized bone matrix and autologous bone marrow [J]. J Pediatr Orthop, 2005, 25(5): 671-675.
16 Kanellopoulos AD, Mavrogenis AF, Papagelopoulos PJ, et al. Elastic intramedullary nailing and DBM-Bone marrow injection for the treatment of simple bone cysts [J]. World J Surg Oncol, 2007, 5:111.
17 Sung AD, Anderson ME, Zurakowski D, et al. Unicameral bone cyst: a retrospective study of three surgical treatments [J]. Clin Orthop Relat Res, 2008, 466(10): 2519-2526.
18 季卫锋, 丁伟航, 马镇川, 等. 三通道髓芯钻孔减压加DBM、自体骨髓干细胞治疗早期股骨头坏死 [J]. 中国骨伤, 2008, 21(10): 776-778.
19 Yang SH, Fu DH, Yang C, et al. Clinical result of structural augmentation with cannulated bone screws for the treatment of osteonecrosis of the femoral head [J]. Orthop Surg, 2009, 1(1): 42-46.
20 Miyamoto RG, Dhotar HS, Rose DJ, et al. Surgical treatment of refractory tibial stress fractures in elite dancers: a case series [J]. Am J Sports Med, 2009, 37(6): 1150-1154.
21 Nguyen V, Wollstein R. Civilian gunshot wounds to the fingers treated with primary bone grafting [J]. J Plast Reconstr Aesthet Surg, 2009, 62(12): E551-E555.
22 Wang BL, Sun W, Shi ZC, et al. Treatment of nontraumatic osteonecrosis of the femoral head using bone impaction grafting through a femoral neck window [J]. Int Orthop, 2010, 34(5): 635-639.
23 Hunt KJ, Anderson RB. Treatment of Jones fracture nonunions and refractures in the elite athlete outcomes of intramedullary screw fixation with bone grafting [J]. Am J Sports Med, 2011, 39(9): 1948-1954.
24 Hsu JE, Wihbey T, Shah RP, et al. Prophylactic decompression and bone grafting for small asymptomatic osteonecrotic lesions of the femoral head [J]. Hip Int, 2011, 21(6): 672-677.
25 Cho HS, Seo SH, Park SH, et al. Minimal invasive surgery for unicameral bone cyst using demineralized bone matrix: a case series [J]. BMC Musculoskelet Disord, 2012, 13(2012): 134-140.
26 Ayoub MA, El-Rosasy MA. Hybrid grafting of post-traumatic bone defects using β-tricalcium phosphate and demineralized bone matrix [J]. Eur J Orthop Surg Traumatol, 2014, 24(5): 663-670.
27 Desai P, Hasan SM, Zambrana L, et al. Bone mesenchymal stem cells with growth factors successfully treat nonunions and delayed unions [J]. HSS J, 2015, 11(2): 104-111.
28 Murray T, Morscher MA, Krahe AM, et al. Fibular allograft and demineralized bone matrix for the treatment of slipped capital femoral epiphysis [J]. Orthopedics, 2016, 39(3): 519-525.
29 Lareau CR, Hsu AR, Anderson RB. Return to play in National football league players after operative jones fracture treatment [J]. Foot Ankle Int, 2016, 37(1): 8-16.
30 Kwok TY, Wong HK. Evolving treatment modality of hand enchondroma in a local hospital: from autograft to artificial bone substitutes [J]. J Orthop Trauma Rehabil, 2016, 20: 19-23.
31 Gundle KR, Bhatt EM, Punt SE, et al. Injection of unicameral bone cysts with bone marrow aspirate and demineralized bone matrix avoids open curettage and bone grafting in a retrospective cohort [J]. Open Orthop J, 2017, 11: 486-492.
32 Cheung S, Westerheide K, Ziran B. Efficacy of contained metaphyseal and periarticular defects treated with two different demineralized bone matrix allografts [J]. Int Orthop, 2003, 27(1): 56-59.
33 Bibbo C, Patel DV. The effect of demineralized bone matrix-calcium sulfate with vancomycin on calcaneal fracture healing and infection rates: A prospective study [J]. Foot Ankle Int, 2006, 27(7): 487-493.
34 Hierholzer C, Sama D, Toro JB, et al. Plate fixation of ununited humeral shaft fractures: effect of type of bone graft on healing [J]. J Bone Joint Surg Am, 2006, 88(7): 1442-1447.
35 Lindsey RW, Wood GW, Sadasivian KK, et al. Grafting long bone fractures with demineralized bone matrix putty enriched with bone marrow: Pilot findings [J]. Orthopedics, 2006, 29(10): 939-941.
36 Park IH, Micic ID, Jeon IH. A study of 23 unicameral bone cysts of the calcaneus: Open chip allogeneic bone graft versus percutaneous injection of bone powder with autogenous bone marrow [J]. Foot Ankle Int, 2008, 29(2): 164-170.
37 Pieske O, Wittmann A, Zaspel J, et al. Autologous bone graft versus demineralized bone matrix in internal fixation of ununited long bones [J]. J Trauma Manag Outcomes, 2009, 3(1): 11-18.
38 Di Bella C, Dozza B, Frisoni T, et al. Injection of demineralized bone matrix with bone marrow concentrate improves healing in unicameral bone cyst [J]. Clin Orthop Relat Res, 2010, 468(11): 3047-3055.
39 Kim JH, Oh JH, Han I, et al. Grafting using injectable Calcium sulfate in bone tumor surgery:Comparison with demineralized bone matrix-based grafting [J]. Clin Orthop Surg, 2011, 3(3): 191-201.
40 Hatzokos I, Stavridis SI, Iosifidou EA, et al. Autologous bone marrow grafting combined with demineralized bone matrix improves consolidation of docking site after distraction osteogenesis [J]. J Bone Joint Surg Am, 2011, 93(7): 671-678.
41 Feng Y, Wang SZ, Jin DX, et al. Free vascularised fibular grafting with OsteoSet(A (R))2 demineralised bone matrix versus autograft for large osteonecrotic lesions of the femoral head [J]. Int Orthop, 2011, 35(4): 475-481.
42 Thordarson DB, Kuehn S. Use of demineralized bone matrix in Ankle/Hindfoot fusion [J]. Foot Ankle Int, 2003, 24(7): 557-560.
43 Rodriguez-Collazo ER, Urso ML. Combined use of the Ilizarov method,concentrated bone marrow aspirate(cBMA),and platelet-rich plasma(PRP)to expedite healing of bimalleolar fractures [J]. Strategies Trauma Limb Reconstr, 2015, 10(3): 161-166.
44 Kulachote N, Sa-Ngasoongsong P, Sirisreetreerux N, et al. Demineralized bone matrix Add-On for acceleration of bone healing in atypical subtrochanteric femoral fracture: a consecutive Case-Control study [J]. Biomed Res Int, 2016, 4061539(2016): 1-8.
45 Tricot M, Deleu PA, Detrembleur C, et al. Clinical assessment of 115 cases of hindfoot fusion with two different types of graft: Allograft plus DBM plus bone marrow aspirate versus autograft plus DBM [J]. Orthop Traumatol Surg Res, 2017, 103(5): 697-702.
46 Dallari D, Savarino L, Albisinni U, et al. A prospective, randomised, controlled trial using a Mg-hydroxyapatite - demineralized bone matrix nanocomposite in tibial osteotomy [J]. Biomaterials, 2012, 33(1): 72-79.
47 Liebergall M, Schroeder J, Mosheiff R, et al. Stem cell-based therapy for prevention of delayed fracture union: a randomized and prospective preliminary study [J]. Mol Ther, 2013, 21(8): 1631-1638.
48 D’agostino P. Barbier O. An investigation of the effect of AlloMatrix bone graft in distal radial fracture:a prospective randomised controlled clinical trial [J]. Bone Joint J, 2013, 95-B(11): 1514-1520.

相似文献/References:

[1]郭晓磊,李晓云,孙嘉怿,等.含生长因子骨移植材料的研究进展和监管现状[J].中华老年骨科与康复电子杂志,2023,(06):373.[doi:10.3877/cma.j.issn.2096-0263.2023.06.007]
　Guo Xiaolei,Li Xiaoyun,Sun Jiayi,et al.The research development and regulatory state-of-art of bone grafts with growth factors[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2023,(04):373.[doi:10.3877/cma.j.issn.2096-0263.2023.06.007]

备注/Memo

备注/Memo:
基金项目：天津市卫生局课题（15KG124）
更新日期/Last Update: 2018-07-30