肩关节镜术后关节腔内注射皮质类固醇激素安全性的系统评价与Meta分析

Safety of intraarticular corticosteroid injections after arthroscopic shoulder surgery:a systematic review and meta-analysis

背景:肩关节镜术后关节内注射皮质类固醇激素是一种有效缓解术后肩部疼痛和僵硬的方法之一,但使用皮质类固醇激素是否会增加肩关节镜术后相关并发症仍有争议。目的:系统评价肩关节镜术后关节腔内注射皮质类固醇激素的安全性及临床疗效。方法:应用计算机检索PubMed、EMBASE、Cochrane Central Register of Controlled Trials(CENTRAL)数据库中肩关节镜术后关节腔内注射皮质类固醇激素的临床对照试验,检索时间为建库至2019年9月。文献数据提取及质量评价由2位研究者按照纳入和排除标准独立进行,采用Rev man 5.3版本软件进行效应量的合并与分析。结果与结论:①共纳入6篇相关文献,包括7418例患者,其中激素注射组3920例、对照组3498例;②Meta分析显示,两组再撕裂率、Constant评分、ASES评分、UCLA评分比较差异均无显著性意义[OR=0.71,95%CI[0.45,1.13],P=0.15;MD=-0.99,95%CI(-12.44,10.46),P=0.87;MD=-0.12,95%CI(-1.80,1.56),P=0.89;MD=-1.46,95%CI(-3.22,0.30),P=0.10];激素注射组肩关节镜术后1个月内感染率高于对照组(P<0.05),两组肩关节镜术后2-4个月的感染率比较差异无显著性意义(P>0.05);③结果表明,肩关节镜术后注射皮质类固醇激素并不会增加术后再撕裂率,但肩关节镜术后1个月内注射类固醇激素会增加术后感染率,因此在肩关节镜术后应用皮质类固醇激素治疗时,临床医师应根据患者实际情况权衡利弊,同时注意避免在术后1个月内注射关节内激素治疗。

BACKGROUND:Intraarticular injection of corticosteroids after arthroscopic shoulder surgery is one of the effective methods to relieve shoulder pain and stiffness after surgery.However,whether the use of corticosteroids will increase the complications associated with arthroscopic shoulder surgery is still controversial.OBJECTIVE:To evaluate the safety and clinical efficacy of corticosteroid injections after arthroscopic shoulder surgery.METHODS:The electronic databases including PubMed,EMBASE and the Cochrane Central Register of Controlled Trials(CENTRAL)were searched for clinical controlled trials of corticosteroid injection into the articular cavity after arthroscopic shoulder surgery from the inception of the databases to September 2019.Data extraction and quality appraisement were performed independently by two investigators according to inclusion and exclusion criteria.Merging and analysis of effect quantities was conducted on RevMan 5.3 software.RESULTS AND CONCLUSION:(1)A total of six comparative studies were included.A total of 7418 patients were enrolled,of which 3920 were in the corticosteroid injections group and 3498 in the control group.(2)Meta-analysis showed that there was no significant difference in tear rate,Constant score,ASES score and UCLA score between the two groups[OR=0.71,95%CI[0.45,1.13],P=0.15;MD=-0.99,95%CI(-12.44,10.46),P=0.87;MD=-0.12,95%CI(1.80,1.56),P=0.89;MD=1.46,95%CI(3.22,0.30),P=0.10].The infection rate of corticosteroid injections group was higher than that of control group(P<0.05).There was no significant difference in infection rate between the two groups 2-4 months after arthroscopy(P>0.05).(3)The results showed that the injection of corticosteroids did not increase the rate of postoperative tear,but the injection of corticosteroids within one month after the operation would increase the rate of postoperative infection.Therefore,when using corticosteroids after the operation,clinicians should weigh the advantages and disadvantages according to the actual situation of patients,and pay attention to avoid injecting intraarticular hormone treatment within 1 month after operation.