选择性COX-2抑制剂和非选择性COX-1和COX-2抑制剂在预防全髋关节置换术后异位骨化的Meta分析  

Selective COX-2 inhibitor versus nonselective COX-1 and COX-2 inhibitor in the prevention of heterotopic ossification after total hip arthroplasty:a meta analysis of randomised trials

作　　者：徐步国[1,2] 薛德挺[1] 王祥华[1] 严世贵[1] 

机构地区：[1]浙江大学医学院附属第二医院骨科,浙江杭州310009 [2]苍南县第三人民医院骨科,浙江温州325804

出　　处：《中国骨伤》2014年第7期609-614,共6页China Journal of Orthopaedics and Traumatology

摘　　要：目的：比较选择性环加氧酶一2（COX一2）抑制剂和传统的非选择性NSAIDs药用于预防全髋关节置换（THA）术后异位骨化（H0）临床疗效。方法：通过计算机检索MEDuNE、EMBASE、CENTRAL、科学引文索引等数据库，收集选择性COX一2抑制剂和非选择性COX-1和COX-2抑制剂用于预防全髋关节置换术后异位骨化的随机临床试验。按照Cochrane协作网的标准对纳入的文献进行质量评估并提取有效数据，应用统计软件Statal0．0版本进行数据分析。比较两组在不同Brooker分期的异位骨化发生率。结果：共纳入4个符合条件的随机对照试验，808例患者。Meta分析结果表明，两组间异位骨化总发病率比较差异无统计学意义（RR=1．08，95％CI：0．71～1．64，=O．73），重度异位骨化发病率（BrookerU，Ⅲ）（RR=0．83，95％CI：0．48～1．42，P=0．49）和任意Brooker分型的HO，两组之间比较差异无统计学意义。在整个研究中，16例接受非选择性COX抑制剂的患者（4．4％）因胃肠道反应终止治疗；而选择性COX-2抑制剂组中10例患者（2．7％）因胃肠道反应终止治疗。结论：选择性COX-2抑制剂与非选择性NSAIDs药用于预防全髋关节置换术后异位骨化同样有效。考虑到非选择性NSAIDs药的胃肠道不良反应，建议选择性COX-2抑制剂的预防全髋关节置换术后异位骨化。To evaluate the clinical efficiency of selective cyclo-oxygenase-2 （COX-2） inhibitor compared to traditional nonselective NSAIDs for the prevention of heterotopic ossification （HO） after total hip arthroplasty （THA）. Meth-olts： By searching Medline, Embase, CENTRAL （Cochrane Central Register of Controlled Trials） and Science Citation Index et al ,only randomised controlled studies of selective COX-2 inhibitors VS nonselective COX-1 and COX-2 inhibitors for the prevention of HO after THA were included. The quality assessment of included studies was evaluated according to the standard of the Cochrane Collaboration, and the data were analysised by statistic software Stata 10.0. The HO incidence of both groups in different degrees was compared. Results： Four eligible randomised controlled trials of totally 808 patients were included. Meta- analysis results showed that no statistically significant difference was found in overall incidence of HO （RR=I.08,95%CI： 0.71-1.64,P=0.73） ,incidence of moderate severe HO （Brooker I/and Ⅲ ） （RR=0.83,95% CI：0.48-1.42,P=0.49） and any grade of Brooker classification between two groups. In all included studies, 16 patients receiving nonselective COX inhibitor （4.4%） discontinued treatment because of gastrointestinal toxicity, whereas 10 patients in the selective COX-2 inhibitor group （2.7%） discontinued for gastrointestinal side effects. Conclusion：The selective COX-2 inhibitors are as equally effective as nonselective NSAIDs for the prevention of HO after THA. Considering the side effects of nonselective NSAIDs, selective COX-2 inhibitors were recommend for the prevention of HO after THA.

关 键 词：骨化 异位性 关节成形术 置换 髋 消炎药 非甾类 META分析 

分 类 号：R971.1[医药卫生—药品]