Substitutos ósseos comparados ao enxerto ósseo autólogo em cirurgia ortopédica: revisão sistemática da literatura

Objective: Based on a systematic literature review, to identify studies with level of evidence 1 to compare bone graft substitutes to autologous bone grafts. Methods: An electronic survey of papers comparing the use of autologous bone graft and a bone graft substitute in orthopedic surgery was performed. Inclusion criteria considered were prospective and randomized clinical trials in orthopedic surgery, with a minimum of 20 patients, involving spine or appendicular skeleton bones, published between January 1990 and January 2006. Results: 22 papers were identified, all of them written in the English language, five of which compared autologous to homologous grafting, seven involving the use of type 2 morphogenetic protein (BMP-2), three evaluating type 7 morphogenetic protein (BMP-7), and RESUMO Objetivo: Identificar, a partir de revisao sistematizada da literatura, estudos clinicos com nivel de evidencia 1 comparando substitutos osseos ao enxerto autologo. Metodos: Realizada busca eletronica de artigos que comparassem o uso do enxerto osseo autologo a um substituto osseo em cirurgia ortopedica. Foram considerados como criterios de elegibilidade ensaios clinicos prospectivos e randomizados em cirurgia ortopedica, com casuistica minima de 20 pacientes, envolvendo ossos da coluna vertebral ou esqueleto apendicular, publicados entre janeiro de 1990 e janeiro de 2006. Resultados: Foram identificados 22 trabalhos, todos em lingua inglesa, dos quais cinco compararam enxerto autologo ao homologo, sete envolveram uso de proteina morfogenetica do tipo 2 (BMP-2), em tres foi avaliada a proteina morfogenetica do tipo 7 (BMPsubstitutos.pmd 09/04/08, 14:40 59 Zabeu JLA, Mercadante MT 60 Rev Bras Ortop. 2008;43(3):59-68 seven using biological ceramic, such as hydroxyapatite, tricalcium phosphate, and calcium sulfate. Results that most suggested equivalence with autologous grafting were found in the papers with BMP-2 in spine surgery, although several objections may be raised regarding theses and the other papers reviewed, relating to method and possible conflict of interest. Conclusion: There are not many papers with high level of evidence to show the clinical applicability of existing bone