Chinese Journal of Tissue Engineering Research ›› 2020, Vol. 24 ›› Issue (9): 1449-1456.doi: 10.3969/j.issn.2095-4344.2515
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Huang Yong1, 2, Zhu Weimin1, Lu
Wei1, Ouyang Kan1, Peng Liangquan1, Liu
Haifeng1, Li Hao1, Feng Wenzhe1, Xu Jian1,
Zhong Mingjin1, Chen Kang1,
Li Ying1, Deng Zhenhan1
Received:
2019-07-23
Revised:
2019-07-27
Accepted:
2019-09-02
Online:
2020-03-28
Published:
2020-02-13
Contact:
Deng Zhenhan, MD, Attending physician, Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen 518035, Guangdong Province, China
About author:
Huang Yong, Master candidate, Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen 518035, Guangdong Province, China; Department of Clinical Medicine, Shenzhen University Health Sciences Center, Shenzhen 518000, Guangdong Province, China
Supported by:
CLC Number:
Huang Yong, Zhu Weimin, Lu Wei, Ouyang Kan, Peng Liangquan, Liu Haifeng, Li Hao, Feng Wenzhe, Xu Jian, Zhong Mingjin, Chen Kang, Li Ying, Deng Zhenhan. Safety of steroid-containing cocktail periarticular injection after knee arthroplasty: a meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(9): 1449-1456.
2.3 偏倚风险评价 采用Cochrane协作工具评估随机对照试验。所有随机对照试验均采用双盲法。6项研究中提到了随机化算法[12,21-22,26-27,29],包括随机数发生器、区组随机化、随机数字表和随机化表。4项研究通过密封信封记录了分配隐藏信息[23-25,28]。其他评估都良好进行,例如:参与者和实施者的盲法、结果评估的盲法、不全结局数据和选择性报告。总体分析纳入文献的偏倚风险较低。 2.4 Meta分析结果 2.4.1 目测类比评分 4项研究提供了目测类比评分的详细数据[12,22,26-27],其中2项研究报道了静息目测类比评分和活动期间目测类比评分[22,27],发现术后第1,3天和术后2周3个时间点的数据符合荟萃分析条件。各研究间术后第1,3天目测类比评分存在显著异质性(I2=82%,I2=76%),采用随机效应模型进行分析;各研究间术后2周目测类比评分无显著异质性(I2=14%),采用固定效应模型进行分析。分析结果显示:类固醇组术后第1天的目测类比评分低于对照组[MD=-1.52,95%CI(-2.94,-0.10),P=0.04],见图2a;两组术后第3天、2周的目测类比评分比较差异无显著性意义[MD=-0.83,95%CI(-2.30,0.64),P=0.27;MD=-0.42,95%CI(-1.19,0.35),P=0.29],见图2b、c。 "
2.4.2 膝关节活动度 7项研究均提供了膝关节活动度详细数据[12,21- 22,24,26-28]。包含11个时间点,分别为术后第1,2,3,4,5天,术后第1,2,4,6周和术后3,6个月。各研究间术后第4周、第3个月和第6个月的膝关节活动度存在显著异质性(I2=94%,I2=93%,I2=81%),采用随机效应模型进行分析。各研究间术后第1,2,3,4,5天,术后第1,2,4,6周和术后3,6个月的膝关节活动度无显著异质性(I2=47%,I2=0%,I2=44%,I2=40%,I2=0%,I2=0%,I2=0%,I2=14%),采用固定效应模型进行分析。分析结果显示:类固醇组术后前5 d的膝关节活动度较对照组明显改善[MD=11.57,95%CI(9.85,13.30,P < 0.000 01;MD=9.03,95%CI(6.67,11.38),P < 0.000 01;MD=5.73,95%CI(0.85,10.60),P=0.02;MD=5.53,95%CI (0.68,10.38),P =0.03;MD=5.90,95%CI(0.87,10.93),P=0.02]。两组术后第1周、2周、4周、6周、3个月、6个月的膝关节活动度比较差异无显著性意义[MD=1.46,95%CI(-1.21,4.13),P=0.28;MD=-1.27,95%CI(-1.21,4.13),P=0.59;MD=-0.57,95%CI(-6.09,4.96),P=0.084;MD=0.91,95%CI(-1.65,3.47),P=0.49;MD=0.19,95%CI(-6.79,7.17),P=0.96;MD=1.84,95%CI(-1.41,5.08),P=0.27],见图3。 "
2.4.7 并发症 10项研究均报告了各种并发症的发生率,如严重的恶心和呕吐、感染和伤口渗血等。各研究间无明显异质性(I2=0%,I2=0%,I2=0%),采用固定效应模型进行分析。分析结果显示:两组并发症总发生率比较差异无显著性意义[OR=1.07,95%CI(0.63,1.82),P=0.81],见图9a;3项研究(225例患者)报告发生了术后感染[12,21,29],两组组感染患者数量比较差异无显著性意义[OR=1.29,95%CI(0.31,5.38),P=0.72],见图9b;4项研究(352例患者)评估了术严重的恶心和呕吐的发生率[22-24,26];结果显示两组中严重的恶心和呕吐发生率比较差异无显著性意义[OR=0.78,95%CI(0.46,1.34),P=0.37],见图9c。 "
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