CAJ | 학술논문

目的系统评价同期多关节置换与分期多关节置换的疗效及经济费用. 方法计算机检索PubMed(1950年1月至2009年1月)、OVID Medline(1950年1月至2009年1月)、OVID Cinahl (1950年1月至2009年1月)、OVID荷兰医学文摘(2009年3月)、中国生物医学文献数据库(1978年1月至2009年1月)、中国学术期刊网(1981年1月至2009年1月),收集比较同期多关节置换与分期多关节置换的随机对照试验(RCT)、临床对照试验、半随机对照试验、队列研究等,评价纳入研究的方法学质量,并提取有效数据进行Meta分析,以比较同期多关节置换与分期多关节置换术后并发症的发生率、日常生活行走能力(ADL)、手术失血量及经济费用的差异. 结果共纳入6个RCT,3个队列研究,包括2465例患者.同期多关节置换与分期多关节置换术后并发症的发生率差异无统计学意义(OR=1.30,95%CI 0.98～1.71,P=0.94).同期多关节置换与分期多关节置换术后ADL差异有统计学意义(Z=5.71,P<0.01).同期多关节置换的手术失血量多于分期多关节置换,差异有统计学意义(Z=18.05,P<0.01).同期多关节置换与分期多关节置换术中置换相同个数关节所需的费用差异有统计学意义(MD=-2.46,95%CI-3.68～-1.24,P<0.01). 结论与分期多关节置换相比,同期多关节置换住院时间和相应花费更少,且康复更快.对于多关节病变,如果病情许可,推荐多关节同期置换.
목적 계통평개동기다관절치환여분기다관절치환적료효급경제비용. 방법 계산궤검색PubMed(1950년1월지2009년1월)、OVID Medline(1950년1월지2009년1월)、OVID Cinahl (1950년1월지2009년1월)、OVID하란의학문적(2009년3월)、중국생물의학문헌수거고(1978년1월지2009년1월)、중국학술기간망(1981년1월지2009년1월),수집비교동기다관절치환여분기다관절치환적수궤대조시험(RCT)、림상대조시험、반수궤대조시험、대렬연구등,평개납입연구적방법학질량,병제취유효수거진행Meta분석,이비교동기다관절치환여분기다관절치환술후병발증적발생솔、일상생활행주능력(ADL)、수술실혈량급경제비용적차이. 결과 공납입6개RCT,3개대렬연구,포괄2465례환자.동기다관절치환여분기다관절치환술후병발증적발생솔차이무통계학의의(OR=1.30,95%CI 0.98～1.71,P=0.94).동기다관절치환여분기다관절치환술후ADL차이유통계학의의(Z=5.71,P<0.01).동기다관절치환적수술실혈량다우분기다관절치환,차이유통계학의의(Z=18.05,P<0.01).동기다관절치환여분기다관절치환술중치환상동개수관절소수적비용차이유통계학의의(MD=-2.46,95%CI-3.68～-1.24,P<0.01). 결론 여분기다관절치환상비,동기다관절치환주원시간화상응화비경소,차강복경쾌.대우다관절병변,여과병정허가,추천다관절동기치환.
Objective To systematically compare the simultaneous and staged multiple joint replacements in terms of efficacy and cost. Methods We identified eligible randomized-controlled trials (RCTs) comparing simultaneous versus staged multiple joint replacements in PubMed (January, 1950 to January, 2009), OVID MEDLINE (January, 1950 to January, 2009), OVID Cinahl (January, 1950 to January, 2009), OVID EBM (1nd Quarter 2009), CBMdisk (January, 1978 to January, 2009), and CNKI (January, 1981 to January, 2009) . We also hand searched 7 Chinese orthopedic journals to identify such trials. Data were extracted and the methodological quality was critically assessed by 2 reviewers independently. Meta-analyses were performed using Reman5. 0 software. Outcomes of interest included postoperative complications, activities of daily living (ADL), blood loss and economic costs. Results Six RCTs and 3 cohort studies involving 2465 patients were included. The results of meta-analyses showed that the complications incidence was not significantly different( OR = 1. 30, 95% CI0. 98 ～ 1.71, P =0. 94) between the 2 groups, but the ADL, blood loss and economic costs were significantly different ( P<0. 01 ). Conclusions Since the simultaneous multiple joint replacement can cause less hospitalization time and costs, it should be recommended if the patient's condition permits. More well-designed and large-scale RCTs are required to clarify the clinical effects of simultaneous multiple joint replacement.