膝动脉栓塞治疗膝骨关节炎继发性疼痛的疗效与安全性荟萃分析  

A meta‑analysis of the efficacy and safety of genicular artery embolization for the treatment of pain secondary to knee osteoarthritis

作　　者：李永奇 王刚刚[1] 王禹基[2] 陶涛[2] 张正宇[3] 郑栋[2] 陈勇[4] 贾中芝[1] 赵进委[1] Li Yongqi;Wang Ganggang;Wang Yuji;Tao Tao;Zhang Zhengyu;Zheng Dong;Chen Yong;Jia Zhongzhi;Zhao Jinwei(Department of Interventional and Vascular Surgery,the Third Affiliated Hospital of Nanjing Medical University,Changzhou Second People′s Hospital,Changzhou 213003,China;Department of Orthopedics,the Third Affiliated Hospital of Nanjing Medical University,Changzhou Second People′s Hospital,Changzhou 213003,China;Department of Rheumatology,the Third Affiliated Hospital of Nanjing Medical University,Changzhou Second People′s Hospital,Changzhou 213003,China;Department of Painology,the Third Affiliated Hospital of Nanjing Medical University,Changzhou Second People′s Hospital,Changzhou 213003,China)

机构地区：[1]南京医科大学第三附属医院,常州市第二人民医院介入血管科,常州213003 [2]南京医科大学第三附属医院,常州市第二人民医院骨科,常州213003 [3]南京医科大学第三附属医院,常州市第二人民医院风湿免疫科,常州213003 [4]南京医科大学第三附属医院,常州市第二人民医院疼痛科,常州213003

出　　处：《中华医学杂志》2024年第45期4162-4170,共9页National Medical Journal of China

基　　金：常州市“十四五”卫生健康高层次人才培养工程(领军人才)(2022CZLJ026)。

摘　　要：目的评价膝动脉栓塞(GAE)治疗膝骨关节炎(KOA)继发性疼痛的疗效与安全性。方法对PubMed、Web of Science、Cochrane Library、Embase和万方数据库进行文献检索,收集KOA与GAE及疗效相关文献,检索时限为建库至2024年7月。按照纳入及排除标准由两名研究者独立进行文献筛选和数据提取工作,并采用了非随机对照试验方法学评价指标对所纳入的文献进行质量评价。提取视觉模拟评分(VAS)量表评分和西安大略和麦克马斯特大学骨关节炎指数(WOMAC)总分以及不良事件发生率,并使用STATA 15.1软件进行荟萃分析。结果依纳排标准共纳入11篇文献,涉及11项研究332例患者(419个膝关节)。技术成功率为100%。VAS评分变化在术后1、3、6、12个月的标准化均数差分别为-2.42(95%CI:-2.89~-1.95)、-2.44(95%CI:-2.94~-1.93)、-2.57(95%CI:-3.13~-2.01)、-2.60(95%CI:-3.37~-1.84),均下降(均P<0.001);WOMAC总分变化在术后1、3、6、12个月的加权均数差分别为-24.44(95%CI:-29.13~-19.75)、-28.30(95%CI:-31.47~-25.12)、-30.66(95%CI:-32.94~-28.37)、-34.23(95%CI:-44.39~-24.07),均下降(均P<0.001)。不良事件主要包括:皮肤颜色变化16.4%(95%CI:5.5%~31.0%,P<0.001)和穿刺部位血肿3.8%(95%CI:1.1%~7.6%,P<0.001),绝大多数为轻度且能自愈。结论GAE治疗KOA继发性疼痛具有良好的疗效和安全性,为KOA患者提供了一种微创的治疗选择。Objective To assess the efficacy and safety of genicular artery embolization(GAE)in the management of pain secondary to knee osteoarthritis(KOA).Methods Literature search was conducted on PubMed,Web of Science,Cochrane Library,Embase,and Wanfang databases to collect literatures related to KOA,GAE and therapeutic effects.The search period was from the inception of the databases to July 2024.Literature screening and data extraction were carried out independently by two researchers according to the inclusion and exclusion criteria,and the quality of the included literature was assessed using the methodological index for non‑randomized studies.Data extracted included visual analog scale(VAS)scores,total western ontario and mcmaster universities osteoarthritis index(WOMAC)scores,and the incidence of adverse events,followed by a meta‑analysis using STATA 15.1 software.Results A total of 11 papers involving 332 patients(419 knees)from 11 studies were included according to the Na‑row criteria.The technical success rate was 100%.The standardized mean differences of VAS scores at 1,3,6,and 12 months postoperatively were-2.42(95%CI:-2.89‑-1.95),-2.44(95%CI:-2.94‑-1.93),-2.57(95%CI:-3.13‑-2.01),and-2.60(95%CI:-3.37‑-1.84),respectively,all showing decreases(all P<0.001);the weighted mean difference of WOMAC total score at 1,3,6,and 12 months after surgery were-24.44(95%CI:-29.13‑-19.75),-28.30(95%CI:-31.47‑-25.12),-30.66(95%CI:-32.94‑-28.37),and-34.23(95%CI:-44.39‑-24.07),all showing decreases(all P<0.001).The incidence of adverse events mainly included skin color changes of 16.4%(95%CI:5.5%‑31.0%,P<0.001)and hematoma at the puncture site 3.8%(95%CI:1.1%‑7.6%,P<0.001),with the majority being mild and self‑resolving.Conclusions GAE treatment for KOA secondary pain has good efficacy and safety,providing a new treatment option for KOA patients as a minimally invasive procedure.

关 键 词：骨关节炎 膝 膝动脉栓塞 疗效 安全性 荟萃分析 

分 类 号：R684.3[医药卫生—骨科学]