全膝关节置换后冷疗有效性的Meta分析  

Meta-analysis of the effectiveness of cold therapy after total knee arthroplasty

作　　者：刘玉 张楠心[1] 戴丽群[1] 应玮 Liu Yu;Zhang Nanxin;Dai Liqun;Ying Wei(Department of Orthopedics,First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,Fujian Provinee,China)

机构地区：[1]福建医科大学附属第一医院骨科

出　　处：《中国组织工程研究》2020年第9期1443-1448,共6页Chinese Journal of Tissue Engineering Research

基　　金：福建省2012年临床重点专科建设项目(骨科)(闽卫科教[2012]149号),项目参与者:张楠心;福建省财政厅资助项目(阅财指[2018]376号),项目参与者:张楠心~~

摘　　要：背景:应用冷疗来促进全膝关节置换后的康复具有一定的理论基础,但冷疗是否可以减少出血、减轻疼痛、促进早期活动度恢复依然存在争议。目的:应用Meta分析评价全膝关节置换后应用冷疗在减少术后出血、减轻疼痛及促进活动度恢复等方面是否具备有效性。方法:检索Medline、EMBASE、Cochrane、中国生物医学文献数据库、CNKI、万方等数据库,查找关于全膝关节置换后应用冷疗与其他康复疗法的随机对照试验,进行数据提取,应用Revman 5.3进行统计学分析,合并效应值。结果与结论:①共纳入10篇随机对照试验文献,包括1 070例患者,试验组全膝关节置换后应用冷疗,对照组应用其他康复疗法;②Meta分析显示:与其他康复疗法比较,全膝关节置换后应用冷疗可改善术后疼痛[MD=-0.75,95%CI(-1.29,-0.21),P=0.006]、减少血红蛋白降低[MD=-12.11,95%CI(-17.66,-6.56),P<0.000 1],但不能减少阿片类药物用量[MD=0.01,95%CI(-0.15,-0.16),P=0.92]、改善关节活动度[MD=6.58,95%CI(-0.54,13.70),P=0.07];③结果表明,全膝关节置换后应用冷疗可有效缓解疼痛、减少术后血红蛋白的降低程度,但对于减少阿片类镇痛剂的应用及改善活动度无显著疗效。BACKGROUND:The use of cold therapy to promote rehabilitation after total knee arthroplasty has a certain theoretical basis,but whether cold therapy can reduce bleeding,reduce pain,and promote early recovery of activity is still controversial.OBJECTIVE:To evaluate the effectiveness of cold therapy in total knee arthroplasty in reducing postoperative bleeding,reducing pain,and promoting recovery of motion range using meta-analysis.METHODS:Medline,EMBASE,Cochrane,China Biomedical Literature Database,CNKI,Wanfang and other databases were searched to find randomized controlled trials of cold therapy and other rehabilitation therapies after total knee arthroplasty.Data were extracted.Statistical analysis was performed using Revman 5.3.Effect values were combined.RESULTS AND CONCLUSION:(1) A total of 10 randomized controlled trials were included,including 1 070 patients.The experimental group received cold therapy after total knee arthroplasty,and the control group received other rehabilitation therapies.(2) Meta-analysis showed that compared with other rehabilitation therapies,cold therapy after replacement alleviated postoperative pain [MD=-0.75,95%Cl(-1.29,-0.21),P=0.006],reduced hemoglobin drop [MD=-12.11,95%CI(-17.66,-6.56),P<0.000 1].However,cold therapy could not reduce the amount of opioids usage [MD=0.01,95%Cl(-0.15,-0.16),P=0.92],or improve joint motion range [MD=6.58,95%CI(-0.54,13.70),P=0.07].(3) The results show that the application of cold therapy after total knee arthroplasty can effectively relieve pain and reduce the drop of postoperative hemoglobin,but has no significant effect on reducing the application of opioid analgesics or improving motion range.

关 键 词：全膝关节置换 冷疗 荟萃分析 疼痛 贫血 活动度 阿片类药物 术后康复 

分 类 号：R459.9[医药卫生—治疗学] R687.4[医药卫生—临床医学]