ABSTRACT
PURPOSE@#To compare the efficacy and safety of recombinant human bone morphogenetic protein (rhBMP) and iliac crest autograft in the fusion treatment of lumbar spondylolisthesis.@*METHODS@#The studies using randomized controlled trials to compare the rhBMP with iliac crest autograft in the treatment of lumbar spondylolisthesis were retrieved from Embase, Pubmed, ProQuest dissertations & theses (PQDT), China national knowledge infrastructure (CNKI), Chinese Biomedical Database, Wanfang Data, Cochrane Library (from March 1998 to March 2018). Postoperative fusion rate, clinical success rate, postoperative intervertebral height, complications, operation time, blood loss and duration of hospitalization were chosen as the outcome indicators. Methodological quality of the trials was critically assessed, and relevant data were extracted. Statistical software Revman 5.3 was used for data-analysis.@*RESULTS@#Eleven articles were included in the meta-analysis. The results showed that, comparing the efficacy of rhBMP with iliac crest autograft, statistical significance was found in the 24-month fusion rate post operation [95% CI (1.38, 24.70), p = 0.02] and operation time [95% CI (-14.22, -2.08), p = 0.008]. There is not sufficient evidence for statistical differences in the remaining indicators.@*CONCLUSION@#The current literature shows rhBMP is a safe and effective grafting material in the treatment of lumbar spondylolisthesis. Further evidence is dependent on the emergence of more randomized controlled trials with higher quality and larger sample sizes in the future.
Subject(s)
Humans , Autografts , Bone Morphogenetic Proteins , Databases, Bibliographic , Ilium , Transplantation , Lumbar Vertebrae , General Surgery , Randomized Controlled Trials as Topic , Recombinant Proteins , Spinal Fusion , Methods , Spondylolisthesis , General Surgery , Time Factors , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To systematically evaluate clinical effects of metal and non-metallic materials in internal fixation for patellar fracture.</p><p><b>METHODS</b>The reports concerning about controlled trial of metallic and non-metallic materials for patellar fracture from create database to June 2018 were searched from PubMed, EMBASE, Web of science, CNKI and Wanfang data. Information was screened and taken out according to inclusion and exclusion criteria by 2 researchers, and risk of bias in non-andomised studies of interventions (ROBINS-I) was used to evaluate literature quality. Rate of reoperation, excellent and good rate of clinical rehabilitation, incidence of postoperative complications were compared with Revman 5.3 software for Meta-analysis.</p><p><b>RESULTS</b>Totally 9 retrospective cohort studies including 493 patients were selected. There was no significant difference in reoperation rate of internal fixation failure between metallic implants and non-metallic implants[OR=0.52, 95% CI (0.25, 1.08) =0.08]. The excellent and good rate of postoperative clinical rehabilitation in patients receiving non-metallic implants were higher than those in receiving metallic implants[OR=3.34, 95% CI (1.67, 6.71), =0.000 7]; incidence of total complications was also lower than that of metallic implants[OR=0.21, 95% CI (0.07, 0.60), =0.003]. There was no significant difference in the incidence of non-metallic related complications after removing Kirschner wire needle and complications of skin irritation [OR=1.08, 95% CI(0.45, 2.56), =0.86].</p><p><b>CONCLUSIONS</b>Non-metallic plants could provide the same success rate of internal fixation as metal plants, could improve the excellent and good rate of postoperative rehabilitation by reducing incidence of complications associated with metallic plants. In further, more evidence-level research is needed to confirm in the future.</p>