Autologous bone grafting versus bone morphogenetic protein treatment for nonunion of long bone fractures in adults：a Meta analysis

Abstract

To systematically evaluate the clinical effects of autologous bone grafting versus bone morphogenetic protein treatment for nonunion of long bone fractures in adults and provide reference for this fracture. According to the methods of systematic review of Cochrane, the randomized controlled trials which compared autologous bone grafting with bone morphogenetic protein treatment for nonunion of long bone fractures in adults were searched in PuMed, Embase, Cochrane library, CNKI , Wangfang data and CBM from the databases were established to March 2019. Information was screened and extracted according to the inclusion and exclusion criteria by two researchers respectively, and the qualities of the included studies were assessed by the modified Jadad quality scale. The rate of infection, successful union, second operation, hospital stays and intraoperative blood loss were compared by RevMan 5.3 software from Cochrane Collaboration for Meta-analysis. Seven randomized controlled trials with a total of 652 patients were included, 410 in the autologous bone grafting group and 242 in the bone morphogenetic protein group. Meta analysis showed there were no statistically significant differences regarding infection［RR=1.32, 95%CI (0.90, 1.93) , P=0.16］, successful union［RR=0.95, 95%CI (0.84, 1.08) , P=0.43］, second operation［RR=1.16, 95%CI (0.43, 3.12) , P=0.76］, hospital stays［MD=0.69, 95%CI (-0.38, 1.75) , P=0.21］between the two groups. But compared with the bone morphogenetic protein treatment, autologous bone grafting significantly increased the intraoperative blood loss［MD=223.00, 95%CI (32.72, 413.28) , P=0.02］. Since bone morphogenetic proteins can attain as the same fracture healing rate as autologous bone grafting and can significantly reduce the intraoperative blood loss, bone morphogenetic proteins may be a better choice for nonunion of long bone fractures in adults.