膝关节置换后注射含类固醇鸡尾酒治疗安全性的荟萃分析

背景:类固醇具有强大的抗炎、止吐及镇痛作用而被广泛用于围术期镇痛,有研究表明膝关节置换后膝关节周围注射含类固醇的鸡尾酒镇痛疗法可缓解术后疼痛、改善膝关节活动度及减少相关并发症,但也有研究认为类固醇可增加术后感染、髌腱断裂等风险。因此膝关节周围注射含类固醇鸡尾酒疗法在膝关节置换后镇痛中的安全性和疗效尚存在争议。目的:通过荟萃分析系统评价膝关节置换后运用含类固醇鸡尾酒疗法镇痛的疗效和安全性。方法:检索PubMed/Medline、Cochrane Central Register of Controlled Trials、EMBASE数据库2019年4月前的文献,收集所有膝关节置换后局部运用类固醇镇痛的随机对照试验,筛选出符合条件的文献。由2名研究者分别单独使用Cochrane 5.0风险偏倚评估工具对文献方法学偏倚进行评价,提取文献数据并用Review Manager 5.2软件进行荟萃分析。结果与结论:①共纳入10篇随机对照试验,820例患者;②Meta分析显示:类固醇组术后第1天的目测类比评分低于对照组[MD=-1.52,95%CI(-2.94,-0.10),P=0.04],术后第1,2,3,4,5天的关节活动度高于对照组[MD=11.57,95%CI(9.85,13.30),P<0.000 01;MD=9.03,95%CI(6.67,11.38),P<0.000 01:MD=5.73,95%CI(0.85,10.60),P=0.02:MD=5.53,95%CI(0.68.10.38),P=0.03;MD=5.90.95%CI(0.87.10.93),P=0.02],吗啡使用量少于对照组[MD=-7.94,95%CI(-14.35,-1.53),P=0.02],住院时间短于对照组[MD=-0.98,95%CI(-1.25,-0.71),P<0.000 01],直腿抬高所需时间短于对照组[MD=0.65,95%CI(-0.86,0.44),P<0.000 01],术后C-反应蛋白水平低于对照组[WMD=-4.82,95%CI(7.41,2.23),P=0.000 3];两组膝关节KSS评分、并发症发生率比较差异无显著意义;③结果表明,膝关节置换后关节周围运用含类固醇的鸡尾酒疗法安全有效。

Safety of steroid-containing cocktail periarticular injection after knee arthroplasty:a meta-analysis

BACKGROUND:Steroids have strong anti-inflammatory,anti-emetic and analgesic effects and are widely used in perioperative analgesia.Studies have shown that periarticular injection of steroid-containing cocktail analgesic therapy in knee arthroplasty can relieve postoperative pain,improve knee activity,and reduce complications.However,the other studies show that steroids can increase the risk of postoperative infection,and tendon rupture.Therefore,the safety and efficacy of steroid-containing cocktail periarticular injection in knee arthroplasty is still controversial.OBJECTIVE:To evaluate the safety and efficacy of steroid-containing cocktail periarticular injection after knee arthroplasty by meta-analysis.METHODS:The published literatures were searched on the databases of PubMed/Medline,Cochrane Central Register of Controlled Trials,and EMBASE until April 2019.All randomized controlled trials of topical steroid analgesia after knee arthroplasty were collected and eligible articles were screened.Two researchers independently assessed the risk of bias and methodological quality of included studies by the Cochrane 5.0.The outcome data were extracted and a meta-analysis was conducted by Review Manager 5.2 software.RESULTS AND CONCLUSION:(1) A total of 10 randomized controlled articles involving 820 patients were included.(2) The meta-analysis showed that visual analogue scale score was lower in the steroid group than in the control group at postoperative 1 day [MD=-1.52,95%C/(-2.94,-0.10),P=0.04].Motion range was higher in the steroid group than in the control group at postoperative 1,2,3,4 and 5 days[MD=11.57,95%CI(9.85,13.30),P<0.000 01;MD=9.03,95%CI(6.67,11.38),P<0.000 01;MD=5.73,95%C/(0.85,10.60),P=0.02;MD=5.5395%CI(0.68,10.38),P=0.03);MD=5.90,95%CI(0.87,10.93),P=0.02].Morphine use was less in the steroid group than in the control group[MD=-7,94,95%CI(-14.35,-1.53),P=0.02].Hospital stay was shorter in the steroid group than in the control group [MD=-0.98,95%C/(-1.25,-0.71),P <0.000 01].Straight leg raising took less time in the steroid group than in the control group [MD=0.65,95%CI(-0.86,0.44),P <0.000 01].Postoperative C-reactive protein level was lower in the steroid group than in the control group [WMD=-4.82,95%CI(7.41,2.23),P=0.000 3].Knee society score and complication rate were not significantly different between the two groups.(3) To conclude,the periarticular injection of steroid-containing cocktails after knee arthroplasty is safe and effective.