放射治疗与非甾体类抗炎药治疗预防髋部手术后异位骨化疗效比较的Meta分析

Efficacy of Irradiation and Non-steroid Anti-inflammatory Drugs in the Treatment and Prevention of Heterotopic Ossification after Hip Surgery:A Meta-analysis

目的比较放射治疗与非甾体抗炎药(NSAIDs)治疗预防髋部手术后异位骨化的疗效。方法根据Cochrane系统评价方法,计算机检索PubMed、EMBase、CENTRAL等数据库,收集关于髋部手术〔全髋关节置换术(THA)或髋臼骨折切开复位内固定术(ORIF)〕后放射治疗(射线组)与NSAIDs治疗(药物组)预防异位骨化的随机对照试验。按照Cochrane协作网的标准对纳入文献进行质量评估并提取有效数据进行Meta分析。结果共纳入8篇符合标准的文献,其中1篇为低质量,7篇为高质量,共1 550例患者。Meta分析结果显示:(1)射线组与药物组总体异位骨化情况比较,差异无统计学意义〔RR=0.81,95%CI(0.51,1.30),P=0.39〕。(2)射线组与药物组THA术后异位骨化情况比较,差异无统计学意义〔RR=0.90,95%CI(0.44,1.85),P=0.77〕;射线组与药物组ORIF术后异位骨化情况比较,差异亦无统计学意义〔RR=0.07,95%CI(0.48,1.02),P=0.07〕。(3)按照Brooker分级进行亚组分析,在Brooker-1级〔RR=0.81,95%CI(0.61,1.08),P=0.16〕、Brooker-2级〔RR=0.75,95%CI(0.46,1.23),P=0.26〕、Brooker-3级〔RR=1.20,95%CI(0.77,1.87),P=0.43〕、Brooker-4级〔RR=0.20,95%CI(0.02,1.68),P=0.14〕患者中,射线组与药物组异位骨化情况比较,差异均无统计学意义。(4)射线组与药物组干预后总体并发症情况比较,差异无统计学意义〔RR=0.71,95%CI(0.30,1.67),P=0.43〕。(5)放射组与药物组干预后出现的切口问题情况比较,差异无统计学意义〔RR=1.71,95%CI(0.95,3.05),P=0.07〕。结论放射治疗与NSAIDs治疗预防髋部手术后异位骨化的疗效相似,无相关禁忌证、经济条件一般的患者可采用NSAIDs治疗,必要时再采用放射治疗。

Objective To evaluate the clinical efficacy of radiation therapy and non - steroid anti - inflammatory drugs （NSAIDs） in the treatment and prevention of heterotopic ossification （HO） after hip surgery. Methods According to Cochrane systematic evaluation method, PubMed, EMBase and CENTRAL were retrieved by computer to collect randomized controlled tri- als （RCTs） on the comparison of radiation therapy and NSAIDs in the treatment and prevention of HO after hip surgery （ THA or ORIF） . The quality of the involved literatures was evaluated according to the standard of Cochrane - Collaboration and meta analysis was conducted after data extraction. Results Eight articles with a total of 1 550 patients were involved into the stud- y. Meta analysis showed that： （ 1 ） The general condition of HO between the radiation group and NSAIDs group showed no statisti- cally significant difference [RR =0. 81, 95%CI （0. 51, 1.30）, P =0. 39] . （2） After THA and ORIF, the HO between the radiation group and NSAIDs group both showed no statistically significant differences [ RR = 0. 90, 95% CI （0. 44, 1.85 ）, P=0. 77; RR =0. 07, 95% CI （0. 48, 1.02）, P =0.071 ] （3） According to Brooker grading, the HO of the two groups among patients of Brooker - 1 level [RR =0. 81, 95%CI （0. 61, 1.08）, P =0. 16], Brooker -2 level [RR =0. 75, 95% CI （0.46, 1.23）, P=0.26], Brooker-3 level [RR=1.20, 95%CI （0.77, 1.87）, P=0.43] and Brooker-4 level [RR =0. 20, 95%CI （0. 02, 1.68）, P =0. 14] all showed no statistically significant differences. （4） After intervention, the overall complication between the two groups showed no statistically significant difference [RR = 0. 71, 95% CI （0. 30, 1.67 ）, P = 0.43] . （5） The incision problems between the two groups after intervention also showed no statistically significant difference [ RR = 1.71, 95 % CI （0. 95, 3.05）, P = 0. 07 ] . Conclusion The efficacies of radiation therapy and NSAIDs are similar in the treatment and prevention of HO after hip surgery. NSAIDs can be adopted for patients without contraindication and having ordinary financial abilities, but they can turn to radiation therapy when necessary.