选择性COX-2抑制剂与非选择性COX抑制剂预防全髋关节置换术后异位骨化的Meta分析

Selective COX-2 inhibitor versus nonselective COX inhibitor in the prevention of heterotopic ossification after total hip arthroplasty: a meta-analysis of randomised trials

目的：旨在明确选择性与非选择性COX抑制剂是否具有相同的预防全髋关节置换术后异位骨化的效果。方法：系统回顾2013年6月之前Medline，Embase，Sciencedirect，OVID，CochrandCentraldatabase和中国生物医学文献数据库中的相关研究。纳入比较选择性COX-2抑制剂与非选择性COX抑制剂预防全髋关节置换术后异位骨化的随机对照试验。结果：共有包含808名患者在内的4项研究符合纳入标准。总体Meta分析结果显示．选择性COX-2抑制剂与非选择性COX抑制剂相比，异位骨化总体发生率（RR=1．13，95％CI0．66-1．95：P=0．66）；中度异位骨化（BrookerⅡ-Ⅲ级）发生率（RR=1．22，95％CI 0．67～2．24，P=0．51）及Brooker分级中其他级别差异均没有显著性。结论：在全髋关节置换术后，选择性COX-2抑制剂与非选择性COX抑制剂具有相同的效果。鉴于非选择性COX抑制剂存在胃肠副作用，我们建议采用选择性COX-2抑制剂预防全髋关节置换术后的异位骨化。

Objective To evaluate whether selective cyclo-oxygenase-2 （COX-2） inhibitors are equally effective compared to nonselective COX inhibitors for the prevention of heterotopic ossification （HO） after total hip arthroplasty using a meta-analysis method. Methods Medline, Embase, Sciencedirect, OVID, Coehrand Central database, CBM, and the other relevant data-bases were searched from 2000 to June 2013. Relevant journals or preceedings were also searched manually. Randomized controlled trials comparing the selective cyclo-oxygenase-2 （COX-2） inhibitors are equally effective compared to nonselective COX inhibitors for the prevention of heterotopie ossification after total hip arthroplasty were included. Clinical outcomes and complications were analysised. Results Four studies encompassing 808 patients were included. Overall, the result of meta-analysis showed that no statistically significant difference was found in overall incidence of HO （RR 1.13 95%CI 0.66-1.95; P = 0.66）, incidence of moderate severe HO （Brooker Ⅱ and Ⅲ ） （RR 1.39 95%CI 0.49-3.95; P = 0.54） and any grade of Brooker classification between two groups. Conclusions The selective COX-2 inhibitors are equally effective as nonselective COX inhibitors for the prevention of HO after THA. Considering the gastrointestinal side effects of nonselective COX inhibitors, we recommend selective COX-2 inhibitors for the prevention of HO after THA. However, future well designed, randomised controlled trials are still needed to further confirm our results.