芒硝外敷对全膝关节置换术后肿痛疗效的Meta分析

Effect of external application with mirabilite on swelling and pain after total knee arthroplasty: a meta-analysis

目的综合评价芒硝外敷对改善膝关节置换术后肿痛的效果。方法计算机检索数据库中公开发表的芒硝外敷干预膝关节置换术后肿痛的随机对照试验。由2名研究者按照纳入排除标准进行文献筛选并提取资料,运用RevMan 5. 3. 3软件进行统计分析。结果共纳入6篇随机对照试验(365例患者)。Meta分析结果:芒硝外敷与常规护理/冰袋外敷相比,在疼痛方面,术后第2天[MD=-0. 83,95%CI(-1. 00,-0. 66),P <0. 01]、术后第3天[M D=-0. 96,95%CI(-1. 65,-0. 28),P <0. 01]、术后1周[M D=-1. 71,95%CI(-2. 53,-0. 89),P <0. 01]、术后2周[M D=-1. 17,95%CI(-1. 90,-0. 45),P <0. 01]差异有统计学意义。在肿胀方面,测量部位为膝上10 cm,术后1周[MD=-1. 51,95%CI(-2. 92,-0. 09),P <0. 05]差异有统计学意义;测量部位为膝下10 cm,术后1周[MD=-1. 12,95%CI(-1. 35,-0. 90),P <0. 01]、术后2周[M D=-1. 64,95%CI(-1. 83,-1. 45),P <0. 01]差异有统计学意义。结论芒硝外敷对于TKA术后肿痛问题,虽起效慢,但疗效显著,随使用时间的推移效果越发明显,并且具有不良反应少,使用时间不受限制,操作方便,价格低廉等优点,值得临床推广。

Objective To evaluate the effect of external mirabilite application on swelling and pain after total knee arthroplasty （TKA）. Methods Randomized controlled trials （RCTs） of ex- ternal application of mirabilite which was used to treat swelling and pain after TKA were searched in databases. Data were collected and extracted by two researchers according to the inclusion and exclusion criteria. A Meta-analysis was performed by using a software of RevMan5.3. Results Totally 6 studies （365 patients） were included. In terms of pain, the difference was statistical sig- nificance on the second day（MD -- -0.83, 95% CI： [ - 1.00, -0.66] ,P 〈0.01 ）, the third day （MD-- -0.96, 95%CI： [ -1.65, -0,28], P〈0.0）,the first week（MD=-1.71,95%CI： [ -2.53, -0. 89],P 〈0. 01） and the second week（MD =- 1. 17,95% CI： [ - 1. 90, -0.45 ], P 〈0.01 ） after surgery. In terms of swelling, there was significant difference in the first week（MD = - 1.12,95% CI： [ - 1.35, -0.90], P 〈0.05） if measured 10 cm above kneejoint, and there was significant difference in the first week（MD = -1. 12, 95% CI： [ -1.35, -0.90], P〈0.01） and in the second week（MD= -1.64, 95%CI： [ -1.83, -1.45],P〈 0.01 ） after surgery if measured 10 cm under knee-joint. Conclusion The external mirabilite application is effective to relieve the swelling and pain after TKA. The efficacy is getting better with prolonged time of external application, and it has the advantages of less adverse reactions, unlim- ited use time, convenience in operation, low price and so on. It is worthy of clinical promotion, as an adjuvant treatment, for accelerating the rehabilitation of patients.