中国组织工程研究
中國組織工程研究
중국조직공정연구
Journal of Clinical Rehabilitative Tissue Engineering Research
2013年
13期
2399-2406
,共8页
杨立宇%王星力%周隆%薛峰%巴根%付勤
楊立宇%王星力%週隆%薛峰%巴根%付勤
양립우%왕성력%주륭%설봉%파근%부근
骨关节植入物%骨关节植入物循证医学%全膝关节置换%纤维蛋白黏合剂%随机对照试验%引流量%输血率%高膝关节活动度%深静脉血栓%Meta 分析
骨關節植入物%骨關節植入物循證醫學%全膝關節置換%纖維蛋白黏閤劑%隨機對照試驗%引流量%輸血率%高膝關節活動度%深靜脈血栓%Meta 分析
골관절식입물%골관절식입물순증의학%전슬관절치환%섬유단백점합제%수궤대조시험%인류량%수혈솔%고슬관절활동도%심정맥혈전%Meta 분석
bone and joint implants%evidence-based medicine of bone and joint implants%total knee replacement%fibrin sealants%randomized control ed trials%drainage volume%transfusion rate%high range of motion of knee joint%deep vein thrombosis%Meta-analysis
背景:纤维蛋白黏合剂作用于全膝关节置换后的止血疗效和安全性的分析一直存在争议.目的:系统评价纤维蛋白黏合剂对对全膝关节置换后的止血效果及安全性的影响.
方法:计算机检索1975年至2012年10月 PubMed,Cochrane Library,EMBASE,OVID 数据库、中国期刊全文数据库、中国生物医学文献数据库、中文科技期刊全文数据库、数字化期刊全文数据库,并手动检索相关骨科杂志.中文检索词:全膝关节置换、膝关节置换、纤维蛋白黏合剂、组织胶水.采用 Jadad 评分标准评价纳入研究的质量,采用 RevMan 5.1软件进行统计学处理.主要观察全膝关节置换后引流量,全膝关节置换后患者输血率,患者平均住院日,置换后膝关节的活动度,并发症如深静脉血栓的发生情况.
结果与结论:共纳入5篇前瞻性随机对照试验,总计310例患者,其中纤维蛋白黏合剂应用组患者为168例,对照组患者为142例.Meta 分析结果显示:膝关节置换后,纤维蛋白黏合剂可明显减少纤维蛋白黏合剂组的置换后引流量(MD=-386.88,95%CI:-583.66--190.10,P <0.01);纤维蛋白黏合剂能够明显降低纤维蛋白黏合剂组患者全膝关节置换后输血的概率(RR=0.53,95%CI:0.42-0.83,P <0.01).纤维蛋白黏合剂可减少纤维蛋白黏合剂组患者的住院时间(MD=-3.56,95%CI:-4.97--2.16, P <0.01),同时改善实验组患者膝关节置换后的膝关节活动程度(MD=16.48,95%CI:5.94-27.02,P <0.01).而下肢深静脉血栓发生率在纤维蛋白黏合剂应用组与对照组之间差异无显著性意义(RR=1.18,95%CI:0.18-7.84,P=0.86).结果证实,纤维蛋白黏合剂可以明显减少全膝关节置换后患者的引流量及输血率,止血疗效较好,但目前尚无证据表明纤维蛋白黏合剂能够增加深静脉血栓的发生率.
揹景:纖維蛋白黏閤劑作用于全膝關節置換後的止血療效和安全性的分析一直存在爭議.目的:繫統評價纖維蛋白黏閤劑對對全膝關節置換後的止血效果及安全性的影響.
方法:計算機檢索1975年至2012年10月 PubMed,Cochrane Library,EMBASE,OVID 數據庫、中國期刊全文數據庫、中國生物醫學文獻數據庫、中文科技期刊全文數據庫、數字化期刊全文數據庫,併手動檢索相關骨科雜誌.中文檢索詞:全膝關節置換、膝關節置換、纖維蛋白黏閤劑、組織膠水.採用 Jadad 評分標準評價納入研究的質量,採用 RevMan 5.1軟件進行統計學處理.主要觀察全膝關節置換後引流量,全膝關節置換後患者輸血率,患者平均住院日,置換後膝關節的活動度,併髮癥如深靜脈血栓的髮生情況.
結果與結論:共納入5篇前瞻性隨機對照試驗,總計310例患者,其中纖維蛋白黏閤劑應用組患者為168例,對照組患者為142例.Meta 分析結果顯示:膝關節置換後,纖維蛋白黏閤劑可明顯減少纖維蛋白黏閤劑組的置換後引流量(MD=-386.88,95%CI:-583.66--190.10,P <0.01);纖維蛋白黏閤劑能夠明顯降低纖維蛋白黏閤劑組患者全膝關節置換後輸血的概率(RR=0.53,95%CI:0.42-0.83,P <0.01).纖維蛋白黏閤劑可減少纖維蛋白黏閤劑組患者的住院時間(MD=-3.56,95%CI:-4.97--2.16, P <0.01),同時改善實驗組患者膝關節置換後的膝關節活動程度(MD=16.48,95%CI:5.94-27.02,P <0.01).而下肢深靜脈血栓髮生率在纖維蛋白黏閤劑應用組與對照組之間差異無顯著性意義(RR=1.18,95%CI:0.18-7.84,P=0.86).結果證實,纖維蛋白黏閤劑可以明顯減少全膝關節置換後患者的引流量及輸血率,止血療效較好,但目前尚無證據錶明纖維蛋白黏閤劑能夠增加深靜脈血栓的髮生率.
배경:섬유단백점합제작용우전슬관절치환후적지혈료효화안전성적분석일직존재쟁의.목적:계통평개섬유단백점합제대대전슬관절치환후적지혈효과급안전성적영향.
방법:계산궤검색1975년지2012년10월 PubMed,Cochrane Library,EMBASE,OVID 수거고、중국기간전문수거고、중국생물의학문헌수거고、중문과기기간전문수거고、수자화기간전문수거고,병수동검색상관골과잡지.중문검색사:전슬관절치환、슬관절치환、섬유단백점합제、조직효수.채용 Jadad 평분표준평개납입연구적질량,채용 RevMan 5.1연건진행통계학처리.주요관찰전슬관절치환후인류량,전슬관절치환후환자수혈솔,환자평균주원일,치환후슬관절적활동도,병발증여심정맥혈전적발생정황.
결과여결론:공납입5편전첨성수궤대조시험,총계310례환자,기중섬유단백점합제응용조환자위168례,대조조환자위142례.Meta 분석결과현시:슬관절치환후,섬유단백점합제가명현감소섬유단백점합제조적치환후인류량(MD=-386.88,95%CI:-583.66--190.10,P <0.01);섬유단백점합제능구명현강저섬유단백점합제조환자전슬관절치환후수혈적개솔(RR=0.53,95%CI:0.42-0.83,P <0.01).섬유단백점합제가감소섬유단백점합제조환자적주원시간(MD=-3.56,95%CI:-4.97--2.16, P <0.01),동시개선실험조환자슬관절치환후적슬관절활동정도(MD=16.48,95%CI:5.94-27.02,P <0.01).이하지심정맥혈전발생솔재섬유단백점합제응용조여대조조지간차이무현저성의의(RR=1.18,95%CI:0.18-7.84,P=0.86).결과증실,섬유단백점합제가이명현감소전슬관절치환후환자적인류량급수혈솔,지혈료효교호,단목전상무증거표명섬유단백점합제능구증가심정맥혈전적발생솔.
@@@@BACKGROUND: There is no systematic evaluation about effectiveness and safety of fibrin sealants in reducing blood drainage after total knee arthroplasty. @@@@OBJECTIVE: To systematical y evaluate the effectiveness and safety of fibrin sealants in reducing blood drainage after total knee arthroplasty. @@@@METHODS: A computer-based search was performed in PubMed database, Cochrane Library, EMBASE database, OVID database, China Journal Ful -text database, Chinese Biomedicine database and Chinese Scientific Journals Ful -text database for randomized control ed trials from 1975 to October 2012 and manual search was performed in the relevant orthopedic journals. The Chinese key words were “total knee arthroplasty, knee joint replacement, fibrin sealants, tissue glue”. The quality of the extracted data was evaluated by Jadad methodological assessment, and Revman 5.1 software was used for the statistical analysis. The blood drainge, rate of transfusion, the average hospital stay, range of motion of knee joint and the rate of deep vein thrombosis after total knee arthroplasty were observed. @@@@RESULTS AND CONCLUSION: A total of 310 cases in five clinical prospective randomized control ed trials were included. Total y 168 patients were enrol ed in the fibrin sealants group and 142 in the control group. Meta-analysis results showed that fibrin sealants could reduce the amount of blood drainage significantly in fibrin sealant group [weighted mean difference (MD)=-386.88, 95% confidence interval (CI): -583.66-, -190.10, P <0.01]; moreover, the rate of transfusion in fibrin sealants group was significantly lower than that in the control group [relative risk (RR)=0.53, 95%CI: 0.42, 0.83, P < 0.01]. Fibrin sealants could reduce the average hospital stay in fibrin sealant group (MD=-3.56, 95%CI: -4.97-2.16, P < 0.01), meanwhile, it could improve the range of motion of knee joint in fibrin sealant group (MD=16.48, 95%CI: 5.94-27.02, P < 0.01). There was no significant difference of deep vein thrombosis between two groups (RR=1.18, 95%CI: 0.18-7.84, P=0.86). The results indicated that fibrin sealants could significantly reduce the blood drainage and rate of transfusion after total knee arthroplasty and had a good hemostatic effect, but there was stil no evidence that the fibrin sealants could increase the incidence of deep vein thrombosis.
