应用双磷酸盐类药物与关节置换翻修发生率关系的Meta分析  

Meta analysis about relationship between revision rate and using bisphosphonates after or before joint replacement

作　　者：韩彪[1,2] 马信龙 马剑雄[1] 王颖[1] 卢斌[1] 孙磊[1] 王岩[1] 张成宝[1,2] 赵兴文[1,2] 李飞 范峥睿[1,2] 

机构地区：[1]天津医院骨科研究所生物力学研究室和数字骨科研究室,天津300050 [2]天津医科大学天津医科大学总医院骨科,天津300070

出　　处：《中华骨与关节外科杂志》2017年第4期289-293,共5页Chinese Journal of Bone and Joint Surgery

基　　金：国家自然科学基金项目(编号:81572154);天津市卫生局科技攻关项目(编号:15KG123);天津市科技重大专项与工程项目(编号:16ZXZNGX00130)

摘　　要：背景:双磷酸盐类药物对关节置换翻修发生率的疗效尚不明确。目的:评价术前或术后较长时间应用双磷酸盐类药物对降低全膝或全髋关节置换(TKA或THA)翻修率是否有效。方法:计算机检索数据库有(检索截止时间为2016年2月):Pub Med、Cochrane Central、MEDLINE、EMBASE、中国生物医学文献数据库、维普中文科技期刊数据库、中国生物医学光盘数据库,并手动检索相关英文及中英文杂志。采用Rev Man 5.3软件进行纳入文献的Meta分析,以试验组和对照组关节置换发生翻修的相对危险度(risk ratio,RR值)为标准,分别评价TKA、THA、TKA/THA的翻修发生率的变化。结果:共纳入5篇文章(病例对照研究1篇、队列研究4篇),总样本量为101409例。Meta分析结果显示,术后较长时间(规律用药时间≥6个月)应用双磷酸盐类药物可明显降低TKA/THA的总翻修率(RR=0.40,95%CI:0.29~0.54)、THA的翻修率(RR=0.47,95%CI:0.37~0.60)、TKA的翻修率(RR=0.30,95%CI:0.23~0.38)。与对照组相比,仅术前应用双磷酸盐类药物对关节置换翻修发生率无显著影响(RR=0.97,95%CI:0.79~1.19)。结论:术后较长时间应用双磷酸盐类药物可明显降低TKA、THA、TKA/THA的翻修率;而仅术前应用双磷酸盐类药物,对关节置换翻修发生率无明显影响。Background：The efficacy of bisphosphonates for arthroplasty is still unclear.Objective：To assess whether postoperative long-term or preoperative applications of bisphosphonates can effectively reduce the revision rate after total knee or total hip arthroplasty （TKA or THA）.Methods：Randomized and non-randomized control trials were searched from PubMed,Cochrane Central,MEDLINE,EMBASE,CBM,CBMdisc,and VIP until February 2016.Meta analysis was performed with RevMan 5.3.Risk ratio was used to estimate the incidence in bisphosphonate group and control group after TKA,THA and TKA/THA.Results：Four cohort studies and one case-control study were included in this meta-analysis.There were totally 101409 cases in these studies.Meta analysis showed that,compared with the control group,total revision rates counld be significantly reduced in patients with postoperative long-term application of bisphosphonates （regular drug treatment time was more than 6 months;TKA/THA：RR=0.40,95%CI：0.29-0.54;THA：RR=0.47,95%CI：0.37-0.60;TKA：RR=0.30,95%CI：0.23-0.38）.There was no statistical difference in the revision incidence between the patients with preoperative application of bisphosphonates and those without use of bisphosphonates （RR=0.97,95%CI：0.79-1.19）.Conclusions：Postoperative long-term application of bisphosphonates can significantly reduce the revision rates of TKA,THA and TKA/THA.However,preoperative one-time use of bisphosphonates can not affect obviously the incidence of revision.

关 键 词：关节置换 双磷酸盐 翻修 META分析 

分 类 号：R687.4[医药卫生—骨科学]