纤维蛋白黏合剂对全膝关节置换后止血效果的影响

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。

Effectiveness of fibrin sealants in reducing blood drainage after total knee arthroplasty

BACKGROUND:There is no systematic evaluation about effectiveness and safety of fibrin sealants in reducing blood drainage after total knee arthroplasty. OBJECTIVE:To systematically 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 Full-text database, Chinese Biomedicine database and Chinese Scientific Journals Full-text database for randomized controlled 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 controlled trials were included. Totally 168 patients were enrolled 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 still no evidence that the fibrin sealants could increase the incidence of deep vein thrombosis.