中国膝关节镜手术相关并发症发生率的系统评价  

Complications of knee arthroscopic surgeries in China: a systematic review

作　　者：张凯搏 毛贝尼 张钟[1] 赖思可 李箭[1] 付维力[1] ZHANG Kaibo;MAO Beini;ZHANG Zhong;LAI Sike;LI Jian;FU Weili(Sports Medicine Center,West China Hospital,Sichuan University,Chengdu,610041,P.R.China)

机构地区：[1]四川大学华西医院运动医学中心

出　　处：《中国循证医学杂志》2019年第12期1400-1408,共9页Chinese Journal of Evidence-based Medicine

基　　金：国家自然科学基金项目（编号：81972123、31741046、81871826）;中央高校基本科研业务费项目（编号：2015SCU04A40）;四川大学创新火花项目（编号：2018SCUH0034）;四川省卫计委课题（编号：18ZD017）;四川省科技厅项目（编号：2017SZ0017）;四川大学华西医院“135”工程项目（编号：ZY2017301）;四川大学华西医院学科卓越发展“135”工程临床研究孵化项目（编号：2019HXFH039）

摘　　要：目的系统评价中国膝关节镜手术的相关并发症和意外发生情况。方法计算机检索CNKI、WanFang Data、VIP、PubMed和EMbase数据库,搜集有关中国膝关节镜手术并发症发生率的横断面研究,检索时限均从建库至2019年3月1日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 12.0软件进行Meta分析。结果最终纳入36个研究,包括20 740例患者。Meta分析结果显示:我国膝关节镜并发症和意外情况的总体发生率为9.71%[95%CI(8.20%,11.23%)]。亚组分析结果显示:我国东部、中部和西部膝关节镜并发症发生率分别为10.04%[95%CI(8.00%,12.14%)]、9.67%[95%CI(6.57%,12.76%)]和7.47%[95%CI(6.20%,8.73%)];三甲医院和非三甲医院膝关节镜手术并发症发生率分别为9.50%[95%CI(7.83%,11.17%)]和10.95%[95%CI(6.75%,15.14%)]。发生率最高的三种并发症为:关节积液肿胀2.16%[95%CI(1.44%,2.87%)]、正常组织结构损伤1.49%[95%CI(0.96%,2.03%)]和关节出血/血肿1.43%[95%CI(1.01%,1.84%)];另外严重的并发症血管神经损伤、血栓相关性疾病和感染发生率分别为:0.06%[95%CI(0.02%,0.11%)]、0.33%[95%CI(0.19%,0.48%)]和0.08%[95%CI(0.03%,0.13%)]。结论当前证据显示,中国膝关节镜手术并发症发生率较高,且并发症类型多样。受纳入文献数量和质量限制,本研究结果尚需更多高质量研究进行验证。Objectives To systematically review the complications of knee arthroscopic surgeries in China.Methods We searched PubMed, EMbase, CNKI, WanFang Data and VIP databases to collect cross-sectional studies on the complications of knee arthroscopic surgeries in China from inception to March 1st, 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using Stata 12.0 software. Results A total of 36 studies involving 20 740 cases were included. The results of meta-analysis showed the incidence rate of complication in knee arthroscopic surgeries in China was 9.71%(95%CI 8.20% to 11.23%).Subgroup analysis showed that the complication incidence rates in the eastern, central and western regions were 10.04%(95%CI 8.00% to 12.14%), 9.67%(95%CI 6.57% to 12.76%) and 7.47%(95%CI 6.20% to 8.73%). The complication incidence rates in the upper first-class and non-upper first-class hospitals were 9.50%(95%CI 7.83% to 11.17%) and10.95%(95%CI 6.75% to 15.14%). The top 3 complication types with highest incidence rate included joint effusion[2.16%(95%CI 1.44% to 2.87%)], accidental injury of native structures[1.49%(95%CI 0.96% to 2.03%)] and hemorrhage[1.43%(95%CI 1.01% to 1.84%)]. Other severe complications including neurovascular injury, thrombosis diseases and infection were 0.06%(95%CI 0.02% to 0.11%), 0.33%(95%CI 0.19% to 0.48%) and 0.08%(95%CI 0.03% to0.13%). Conclusions Current evidence shows that the complication incidence rate of arthroscopic surgeries in China is relatively high and the complication type is complex and varied. Due to the quantity and quality of the included studies,more high-quality studies are required to verify the above conclusions in future.

关 键 词：膝关节镜 并发症 意外情况 发生率 系统评价 META分析 横断面研究 

分 类 号：R68[医药卫生—骨科学]