关节镜下清理术联合关节内透明质酸注射治疗膝关节骨关节炎有效性的系统评价  

Intra-Articular Hyaluronic Acid Injection after Arthroscopic Debridement for Knee Osteoarthritis:A Systematic Review

作　　者：蒋勰[1] 占美[2] 李棋[1] 刘东[1] 李箭[1] 

机构地区：[1]四川大学华西医院骨科,成都610041 [2]四川大学华西医院药剂科,成都610041

出　　处：《中国循证医学杂志》2012年第11期1361-1366,共6页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价关节镜下清理术联合关节内透明质酸注射治疗膝关节骨关节炎的有效性。方法计算机检索The Cochrane Library、SCI、MEDLINE、EMbase、CBM和WanFang Data,查找所有关节镜下清理术联合关节内透明质酸注射(联合疗法)与二者任一单一疗法比较治疗膝关节骨关节炎的随机对照试验,检索时限均从建库至2012年。由2位研究者按照纳入和排除标准独立筛选文献、提取资料并评价质量后,采用RevMan 5.0软件进行Meta分析。结果最终纳入7个随机对照试验,共526例患者。Meta分析结果显示联合治疗与单用关节内透明质酸注射[RR=1.40,95%CI(0.99,1.98),P=0.06]或单纯关节镜下清理术[RR=1.09,95%CI(0.93,1.26),P=0.29]治疗膝关节骨关节炎的优良率相似,其差异无统计学意义。但单用关节内透明质酸注射治疗在改善患者Lysholm评分方面不及联合治疗,两组差异有统计学意义[MD=–14.81,95%CI(–17.55,–12.08),P<0.000 01]。结论关节镜下清理术联合关节内透明质酸注射治疗膝关节骨关节炎的优良率与单一疗法的差异无统计学意义,但Lysholm评分高于单用透明质酸注射治疗,联合疗法具有一定优势。受纳入研究数量和质量限制,上述结论尚需开展更多高质量的随机对照试验加以验证。Objective To systematically evaluate the effectiveness of intra-articular hyaluronic acid injection after arthroscopic debridement for knee osteoarthritis （KOA）. Methods Databases including The Cochrane Library, SCI, MEDLINE, EMbase, CBM and WanFang Data were searched from inception to 2012, so as to collect randomized con- trolled trials （RCTs） on intra-articular hyaluronic acid injection after arthroscopic debridement （combined therapy） vs. monotherapy in treating KOA. Two reviewers independently screened literature according to inclusion and exclusion cri- teria, evaluated quality, and extracted data. Then the meta-analysis was conducted using RevMan5.0 software. Results A total of 7 RCTs involving 526 patients were included. The results of meta-analyses showed that： there was no significant difference in the excellent-good rate between the combined therapy group and the monotherapy groups including either the intra-articular hyaluronic acid injection group （RR= 1.40, 95%CI 0.99 to 1.98, P=0.06） or the arthroscopic debridement group （RR=I.09, 95%CI 0.93 to 1.26, P=0.29）. But the intra-articular hyaluronic acid injection group was inferior to the combined therapy group in improving Lysholm score, with a significant difference （MD= -14.81, 95%CI -17.55 to -12.08, P〈0.000 01）. Conclusion Arthroscopic debridement combined with intra-articular hyaluronic acid injection for KOA shows no significant difference in the excellent-good rate compared with the monotherapy, but it is superior to the mono- therapy of hyaluronic acid injection in improving Lysholm score, so it is believed the combined therapy group is superior to the control groups in therapeutic effects. Due to the limited quantity and quality of the included studies, this conclusion needs to be proved by performing more high quality RCTs.

关 键 词：关节镜下清理术 膝关节骨关节炎 透明质酸 系统评价 Meta分析 随机对照试验 

分 类 号：R684.3[医药卫生—骨科学]