全膝关节置换术术中注射类固醇激素的系统评价(英文)  

Glucocorticoid injection during total knee arthroplasty

作　　者：岳海源[1] 崔兆辉[1] 任冬青[1] 滕元君[1] 夏亚一[1] 

机构地区：[1]兰州大学第二医院骨科,中国730030

出　　处：《中国矫形外科杂志》2015年第6期481-487,共7页Orthopedic Journal of China

摘　　要：[目的]对TKA术中类固醇激素注射的有效性及安全性进行评价。[方法]计算机检索Pubmed（1966~2014.5）,EMBASE（1984~2014）及Cochrane Library等数据库,搜集有关TKA术中是否增加类固醇激素注射的RCTs,比较TKA术后的疗效及安全性。2名研究者独立筛选文献并提取数据,使用Cochrane Handbook 5.1对文献质量进行严格评估。[结果]8篇RCT共纳入503例患者。研究结果显示：TKA术中注射类固醇激素能够降低VAS评分、CRP水平、PONV发生率及吗啡消耗量,缩短住院时间并提高早期ROM（P〈0.05）,而在术后并发症方面两者未表现出显著性差异（P〉0.05）。[结论]目前的证据表明,TKA术中类固醇激素注射可以控制炎症、减少术后疼痛及恶心呕吐的发生,增加患者早期关节活动度并缩短住院时间,且不会增加术后并发症的风险。此外,类固醇激素注射的最佳剂量和长期效果仍需更多的研究去验证。[Objective]Purposes A systematic review and meta-analysis based on randomized controlled trials（ RCTs） was conducted to evaluate the efficacy and safety of glucocorticoid injection in total knee arthroplasty（ TKA）. [Method]A systematical search was performed to identify the eligible RCTs in the databases of PubM ed（ 1966 to July 2014）,CENTRAL（ Cochrane Controlled Trials Register; issue 10,2013）,and EMBASE（ 1984- 2014）. Two independent reviewers completed data collection and assessment of methodological quality. Meta-analysis was performed for the outcomes of visual analogue pain score（ VAS）,range of motion（ ROM）,postoperative nausea and vomiting（ PONV）,C-reactive protein（ CRP）,morphine consumption,Hospitalization time and complications. [Result]A total of 503 patients were screened for total knee arthroplasty in eight studies. The final results showed that,the steroid group showed significantly reduction in pain score,CRP levels,the incidence of PONV,morphine consumption,hospitalization time,and improvement short-term in functional recovery（ ROM）（ P 0. 05）.There was no statistically significant difference in complications（ P 0. 05）. [Conclusion]The current evidence suggests that the steroid injection provide short-term advantages in pain relief,inflammation control,antiemetic effects,and hospitalization time. There is no significant difference in complications. The optimal dose and long-term effects of steroid injection are still requires numerous studies.

关 键 词：全膝关节置换术 TKA 糖皮质激素 Meta分析 随机对照试验 

分 类 号：R687.4[医药卫生—骨科学]