BACKGROUND A systematic review assessing autologous versus alloplastic bone for secondary alveolar bone grafting in patients with cleft lip and palate was published in 2011 and included only one randomized controlled trial comparing traditional iliac bone graft to recombinant human bone morphogenetic protein-2 (rh-BMP2). OBJECTIVES To perform a systematic review with meta-analysis on the use of secondary alveolar bone grafting (autologous bone and rh-BMP2 graft) in order to improve bone volume and height in patients with cleft lip and palate. DATA SOURCES An electronic search was conducted via PubMed/MEDLINE, Cochrane Central Register of Controlled Trials (CONTROL) via Cochrane Library, EMBASE via Ovid, and LILAC for studies published between January 2008 and September 2018. The systematic review registration number at PROSPERO was 42018085858. ELIGIBILITY CRITERIA Only RCTs were included. Inclusion criteria were patients with the diagnosis of unilateral cleft lip and palate older than 5 years of age, radiographic evaluation (CT and/or CBCT) of the cleft area, and at least a 6-month follow-up. MAIN OUTCOME MEASURES Bone formation and bone height by radiographic CT evaluation (preoperatively, after 6 months and after 1 year of follow-up) and length of hospital stay were assessed. RESULTS Four studies met strict inclusion criteria. Autologous bone graft showed statistically significant higher bone formation after 6-month follow-up (MD - 14.410; 95% CI - 22.392 to - 6.428; p = 0.000). No statistically significant difference was noted after a 1-year follow-up (MD 6.227; 95% CI - 15.967 to 28.422; p = 0.582). No statistically significant difference in bone height was noted after 6-month (MD - 18.737; 95% CI - 43.560 to 6.087; p = 0.139) and 1-year follow-up (MD - 4.401; 95% CI - 30.636 to 21.834; p = 0.742). Patients who underwent rh-BMP2 graft had a statistically significant reduced hospital stay (MD - 1.146; 95% CI - 2.147 to - 0.145; p = 0.025). LIMITATIONS The main limitation is the high risk of bias among included studies. CONCLUSION Autologous bone and rh-BMP2 graft showed a similar effectiveness in maxillary alveolar reconstruction in patients with unilateral cleft lip and palate assessing bone graft volume and height although rh-BMP2 graft showed a relative shorter length of hospital stay (high uncertainty level).

中文翻译：

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使用自体与异体材料进行二次牙槽骨移植治疗唇腭裂患者：系统评价和荟萃分析。

背景 2011 年发表了一篇评估自体骨与异体骨在唇腭裂患者中进行二次牙槽骨移植的系统评价，其中仅包括一项比较传统髂骨移植物与重组人骨形态发生蛋白-2 (rh-BMP2) 的随机对照试验. 目的 对使用二次牙槽骨移植（自体骨和 rh-BMP2 移植）进行系统评价和荟萃分析，以改善唇腭裂患者的骨量和高度。数据来源 通过 PubMed/MEDLINE、Cochrane 对照试验中央注册中心 (CONTROL) 通过 Cochrane Library、EMBASE 通过 Ovid 和 LILAC 对 2008 年 1 月至 2018 年 9 月期间发表的研究进行了电子搜索。PROSPERO 的系统评价注册号为 42018085858 . 资格标准 仅纳入 RCT。纳入标准是诊断为大于 5 岁的单侧唇腭裂、裂区的放射学评估（CT 和/或 CBCT）以及至少 6 个月的随访的患者。主要结局指标 通过 X 线 CT 评估（术前、6 个月后和 1 年随访后）和住院时间评估骨形成和骨高度。结果 四项研究符合严格的纳入标准。在 6 个月的随访后，自体骨移植显示出具有统计学意义的更高骨形成（MD - 14.410；95% CI - 22.392 至 - 6.428；p = 0.000）。1 年随访后未发现统计学上的显着差异（MD 6.227；95% CI - 15.967 至 28.422；p = 0.582）。6 个月（MD - 18.737；95% CI - 43.560 至 6.087；p = 0.139）和 1 年随访（MD - 4.401；95% CI - 30.636 至 21.834；95% CI - 30.636 至 21.834； p = 0.742）。接受 rh-BMP2 移植的患者住院时间显着缩短（MD - 1.146；95% CI - 2.147 至 - 0.145；p = 0.025）。局限 主要局限是纳入研究的偏倚风险高。结论 自体骨和 rh-BMP2 移植物在评估骨移植体积和高度的单侧唇腭裂患者的上颌牙槽骨重建中显示出相似的效果，尽管 rh-BMP2 移植物显示出相对较短的住院时间（高度不确定性）。接受 rh-BMP2 移植的患者住院时间显着缩短（MD - 1.146；95% CI - 2.147 至 - 0.145；p = 0.025）。局限 主要局限是纳入研究的偏倚风险高。结论 自体骨和 rh-BMP2 移植物在评估骨移植体积和高度的单侧唇腭裂患者的上颌牙槽骨重建中显示出相似的效果，尽管 rh-BMP2 移植物显示出相对较短的住院时间（高度不确定性）。接受 rh-BMP2 移植的患者住院时间显着缩短（MD - 1.146；95% CI - 2.147 至 - 0.145；p = 0.025）。局限 主要局限是纳入研究的偏倚风险高。结论 自体骨和 rh-BMP2 移植物在评估骨移植体积和高度的单侧唇腭裂患者的上颌牙槽骨重建中显示出相似的效果，尽管 rh-BMP2 移植物显示出相对较短的住院时间（高度不确定性）。