Chinese Journal of Tissue Engineering Research ›› 2013, Vol. 17 ›› Issue (13): 2399-2406.doi: 10.3969/j.issn.2095-4344.2013.13.017
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Yang Li-yu, Wang Xing-li, Zhou Long, Xue Feng, Ba Gen, Fu Qin
Received:
2012-11-27
Revised:
2012-12-12
Online:
2013-03-26
Published:
2013-03-26
Contact:
Fu Qin, Professor, Doctoral supervisor, Chief physician, Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
qinfucmu@hotmail.com
About author:
Yang Li-yu★, Studying for master’s degree, Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
mark19871106@126.com
CLC Number:
Yang Li-yu, Wang Xing-li, Zhou Long, Xue Feng, Ba Gen, Fu Qin. Effectiveness of fibrin sealants in reducing blood drainage after total knee arthroplasty[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(13): 2399-2406.
根据Cochrane 协作网提供的指导手册(5.1版),为了减少由于纤维蛋白黏合剂使用剂量的不同而造成的偏倚,实验进行了亚组分析,将10 mg及以上划为高剂量组,小于10 mg为低剂量组。其中1篇文献分别介绍了不同剂量纤维蛋白黏合剂止血效果的疗效[8],实验根据指导手册将这篇文献的对照组平均拆分为各15例,计数资料、计量资料分析均采用亚组分析的方式。由于相关并发症的内容没有具体叙述来自于何种剂量的患者,实验将采用了不同剂量的纤维蛋白黏合剂患者合并作为单一实验组进行分析。 2.3 Meta分析结果 置换后引流量:在5篇研究中,共有3个研究患者(159例)报告了置换后引流量[7-8, 11]。其他2个研究[9-10]置换后出血量是根据置换前置换后红细胞比容之差计算出来的,无直接观测值,未纳入分析之中。3篇文献分成高剂量与低剂量亚组分析,见图2。异质性分析可见高剂量组:χ2=35.58,P < 0.01,I2=97%;低剂量组:χ2=0.16,P=0.69,I2=0%,总异质性:χ2= 42.86,P < 0.01,I2=93%,异质性较大的采用随机效应模型。结果显示,高剂量组:SMD=-400.62,95%CI:-756.14- -45.10,Z=2.21,P=0.03;低剂量组WMD= -390.74,95%CI:-498.14- -283.33;低剂量组Z=7.13,P < 0.01。两组合并总效应量:WMD=-386.88,95%CI:-583.66- -190.10,Z=3.85,P < 0.01,说明两组都能减少置换后引流量。"
置换后膝关节活动度的恢复:有2篇文献(114例患者)报道了置换后膝关节活动恢复的相关数据[7-8]。低剂量组(χ2= 18.98,P < 0.01,I2=95%)与整体效应(χ2=28.60,P < 0.01,I2=93%)来看均存在较大异质性,见图6,故实验采用随机效应模型。从统计学上来看可见高剂量组与整体效应上都能较好地改善患者置换后膝关节活动度的恢复,而低剂量组的改善情况不明显(高剂量组:WMD=23.10,95%CI:18.39-27.81,Z=9.61,P < 0.01;低剂量组:WMD=13.14,95%CI:-1.95- 28.23,Z=1.71,P=0.09;整体效应:WMD=16.48,95%CI:5.94-27.02,Z=3.06,P < 0.01)。"
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