糖尿病与膝关节置换术后并发症相关性的Meta分析

Correlation between diabetes and complications after total knee arthroplasty: a meta-analysis

[目的]系统评价糖尿病与膝关节置换术后并发症的相关性。[方法]计算机检索电子数据库Pubmed,EMbase,The Cochrane library(2017年第11期),CBM,中国知网(CNKI),万方(Wan Fang),搜集糖尿病对膝关节置换术后并发症发生风险相关性的观察性研究,检索时间均为自建库至2017年11月。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,运用Revman 5.3软件进行Meta分析。[结果]最终纳入16篇文献,共626 535例患者。Meta分析结果显示:糖尿病人群接受膝关节置换术后发生深部感染的风险是非糖尿病人群的1.66倍(OR=1.66,95%CI=1.46~1.89,P<0.001),糖尿病人群接受膝关节置换术后发生深静脉血栓(deep vein thrombosis,DVT)的风险是非糖尿病人群的1.48倍(OR=1.48,95%CI=1.22~1.80,P<0.001),糖尿病人群接受膝关节置换术后的膝关节功能评分(KSS)低于非糖尿病组,差异有统计学意义(SMD=-0.13,95%CI=-0.24^-0.01,P=0.04)。森林结构图显示本次研究结果较为稳健,漏斗图提示存在发表偏倚的可能性较小。[结论]糖尿病与膝关节置换术后并发症具有相关性,糖尿病可增加膝关节置换术后并发症的发病风险。

[Objective] To explore the relationship between diabetes and complications after total knee arthroplasty.[Methods] The databases including Pub Med, EMbase, Cochrane Library, CBM, CNKI and Wan Fang Data were electronically searched for the published studies involving the investigation of the association between diabetes melitus and postoperative complications of total knee arthroplasty（TKA） from inception of November 2017. Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies. Then, a meta-analysis was performed using Rev Man 5.3 software. [Results] A total of 16 studies involving 626 535 patients were included. The results of mata-analysis showed that risk of occurrence of deep infection after TKA in diabetic population was 1.66 times of the non-diabetic population（OR=1.66, 95%CI=1.46 to 1.89, P〈0.001）, risk of occurrence of deep vein thrombosis was 1.48 times of non-diabetic population（OR=1.48, 95%CI=1.22 to 1.80, P〈0.001） and Knee Society scores in the diabetic population were less than that of non-diabetic population with significant difference（SMD=-0.13, 95%CI=-0.24 to-0.01, P=0.04）. [Conclusion] Diabetes melitus is associated with postoperative complications after TKA.