持续被动运动锻炼对全膝关节置换术后患者下肢深静脉血栓及膝关节功能影响的Meta分析

A meta-analysis of the effect of continuous passive motion exercise on lower limb deep vein thrombosis and knee joint function in patients after total knee arthroplasty

目的系统评价持续被动运动锻炼对全膝关节置换术后患者下肢深静脉血栓、膝关节功能的作用。方法检索CNKI、万方、VIP、Proquest、CIHNAL、JBI、cochrane library、Web of science、PubMed、Embase等数据库,查找所有符合纳入和排除标准的中英文文献,进行文献质量双人评价,纳入的文献利用RevMan 5.3进行Meta分析。结果纳入16项随机对照试验,Meta分析结果表明:与常规主动运动相比,膝关节置换术后患者运用持续被动运动锻炼可以提高早期膝关节活动度[WMD=4.12,95%CI(0.98,7.25),P=0.01],但在预防膝关节置换术后下肢静脉血栓[OR=0.64,95%CI(0.18,2.32),P=0.50]、膝关节功能[WMD=0.09,95%CI(-0.05,0.23),P=0.23]、术后疼痛[WMD=0.05,95%CI(-0.11,0.22),P=0.54]、住院时间[WMD=0.33,95%CI(-0.2,0.85),P=0.23]等方面无明显作用。结论膝关节置换术后患者持续被动运动锻炼可以改善膝关节早期活动度,但尚无足够证据表明持续被动运动锻炼可以降低下肢静脉血栓、改善膝关节功能、改善术后疼痛、缩短住院时间。

Objective To evaluate the effectiveness of continuous passive motion(CPM)exercise on lower limb deep vein thrombosis and knee joint function on patients after total knee arthroplasty.Methods Databases like CNKI,Wanfang,VIP,Proquest,CIHNAL,JBI,cochrane library,Web of science,PubMed,Embase were reached,all the suitable Chinese and Engliash literature were collected,to had literature quality double evaluation.The Meta analysis was performed using RevMan5.3 software.Results Sixteen randomized controlled trials were included.Meta-analysis showed that patients with knee arthroplasty had improved knee mobility by using CPM exercise compared with conventional ostoperative pain[WMD=4.12,95%CI(0.98,7.25),P=0.01],but in prevention of lower extremity venous thrombosis after knee arthroplasty[OR=0.64,95%CI(0.18,2.32),P=0.50],knee function[WMD=0.09,95%CI(-0.05,0.23),P=0.23],postoperative pain[WMD=0.05,95%CI(-0.11,0.22),P=0.54],hospitalization[WMD=0.33,95%CI(-0.2,0.85),P=0.23]had no obvious effect.Conclusion CPM exercise can improve the active knee flexion in knee joint after knee arthroplasty.However,there is not enough evidence to show that CPM exercise can reduce venous thrombosis of lower extremities,improve knee function,reduce postoperative pain and shorten hospital stay.