关节镜清理联合透明质酸钠注射治疗老年膝骨关节炎:疼痛、炎症因子及关节功能变化的Meta分析

Arthroscopic debridement combined with sodium hyaluronate injection for the treatment of senile knee osteoarthritis:a Meta-analysis of changes in pain,inflammatory factor,and joint function

目的:相关临床研究表明关节镜清理联合透明质酸钠治疗老年膝骨关节炎具有积极的作用,然而其有效性及安全性尚未完全明确,缺乏充足的循证依据。文章以此对关节镜清理联合透明质酸钠治疗老年膝骨关节炎的临床疗效进行Meta分析。方法:计算机检索PubMed、Cochrane Library、Web of science、EMbase、维普、中国知网、CBM、万方数据库以及百度学术资源系统中关节镜清理联合透明质酸钠注射治疗老年膝骨关节炎的随机对照试验,检索时间2016-01-01/2020-10-30。由2名研究者独立完成检索和筛选文献,利用Cochrane风险偏倚评估工具对纳入研究进行质量评价,提取数据资料并运用RevMan 5.3软件进行Meta分析。结果:①共纳入12项随机对照试验,包括老年单侧膝骨关节炎患者1072例。②Meta分析结果显示,对比单纯关节镜清理术,联合透明质酸钠注射治疗老年膝骨关节炎具有更高的临床总有效率(RR=1.24,95%CI:1.15-1.33,P<0.00001),在Lysholm评分(SMD=9.80,95%CI:8.09-11.51,P<0.00001)和目测类比评分(MD=-1.19,95%CI:-1.58至-0.80,P<0.00001)上更有优势,而且膝关节液白细胞介素1水平(MD=-9.95,95%CI:-11.31至-8.59,P<0.00001)、白细胞介素6水平(MD=-33.68,95%CI:-42.42至-24.93,P<0.00001)和肿瘤坏死因子α水平(MD=-84.72,95%CI:-91.49至-77.95,P<0.00001)更低,两组不良反应发生率无显著差异(RR=0.60,95%CI:0.30-1.18,P=0.14)。结论:与单纯关节镜清理术相比,关节镜清理联合透明质酸钠治疗老年膝骨关节炎具有更高的临床疗效,具体体现在缓解关节疼痛、改善膝关节功能和降低炎性因子水平方面,但未来仍需更多质量高、样本量大的随机对照试验加以验证。

OBJECTIVE:Relevant clinical studies have shown that arthroscopic debridement combined with sodium hyaluronate plays a positive role in the treatment of senile knee osteoarthritis,but its efficacy and safety are not completely clear,lack of sufficient evidence-based basis.Herein,we conducted a Meta-analysis on the clinical efficacy of arthroscopic debridement combined with sodium hyaluronate in the treatment of senile knee osteoarthritis.METHODS:A systematic search of relevant literatures in PubMed,Cochrane library,EMbase,Web of Science,CNKI,CBM,WanFang and Baidu Scholar from January 1,2016 to October 30,2020 was performed.We collected all the randomized controlled trials of arthroscopic debridement combined with sodium hyaluronate injection in the treatment of senile knee osteoarthritis.Two researchers screened the study strictly according to the inclusion and exclusion criteria,and extracted data and evaluated the quality of the literature.Meta-analysis of the included literatures was processed by Revman5.3 software.RESULTS:A total of 12 randomized controlled trials were collected in this meta-analysis,including 1072 knees in the experimental group and 532 in the control group.The results of Meta-analysis showed that arthroscopic debridement combined with sodium hyaluronate injection in the treatment of senile knee osteoarthritis was superior to arthroscopic debridement alone with regard to the total clinical effective rate(relative risk(RR)=1.24,95%confidence interval(CI):1.15 to 1.33,P<0.00001),Lysholm score(standardized mean difference(SMD)=9.80,95%CI:8.09 to 11.51,P<0.00001),and Visual Analogue Scale score(MD=-1.19,95%CI:-1.58 to-0.80,P<0.00001).Compared with the arthroscopic debridement alone,the combination therapy showed a significant decrease in the levels of intra-articular interleukin-1(MD=-9.95,95%CI:-11.31 to-8.59,P<0.00001),interleukin-6(MD=-33.68,95%CI:-42.42 to-24.93,P<0.00001)and tumor necrosis factor-α(MD=-84.72,95%CI:-91.49 to-77.95,P<0.00001).There was no significant difference in the incidence of complications between the two groups(RR=0.60,95%CI:0.30 to 1.18,P=0.14).CONCLUSION:Compared with arthroscopic debridement alone,arthroscopic debridement combined with sodium hyaluronate is more effective in the treatment of senile knee osteoarthritis,which is embodied in relieving joint pain,improving knee joint function and reducing the level of inflammatory factors.However,more randomized controlled trials with high quality and large sample size are still needed in the future.