芒硝外敷减轻全膝关节置换术后早期膝关节肿痛的有效性Meta分析

Clinical efficacy of external application of mirabilite for relieving early knee swelling and pain after total knee arthroplasty:a meta-analysis

目的:系统评价芒硝外敷减轻全膝关节置换术(total knee arthroplasty,TKA)后早期膝关节肿痛的有效性。方法:应用计算机检索中国生物医学文献数据库、万方数据库、中国知网、维普网、Cochrane Library、Web of Science、PubMed、Embase建库至2021年4月收录的比较常规冰敷(对照组)与单独芒硝外敷或常规冰敷联合芒硝外敷(试验组)减轻TKA术后早期膝关节肿痛的有效性的随机对照试验研究文献。由2名研究者按照纳入、排除标准独立进行文献筛选和数据提取,采用Cochrane偏倚风险评估工具对纳入的文献进行质量评价,采用Cochrane协作网提供的RevMan5.4软件进行Meta分析,采用GRADE profiler3.6软件进行证据质量评价。结果:共检索出57篇文献,经逐层筛选,最终纳入8篇文献,均为中文文献。Meta分析结果显示,2组患者术后48h、72h膝关节疼痛视觉模拟量表(visual analogue scale,VAS)评分的组间差异均无统计学意义[术后48h:I^(2)=0%,P=0.900;MD=-0.18,95%CI(-0.48,0.12),P=0.230。术后72h:I^(2)=0%,P=1.000,MD=-0.07,95%CI(-0.24,0.10),P=0.410],试验组术后7d膝关节疼痛VAS评分低于对照组[I^(2)=91%,P=0.000;MD=-0.61,95%CI(-0.93,-0.28),P=0.000];试验组术后3d、7d膝关节上方10cm处周径均小于对照组[术后3d:I^(2)=79%,P=0.000;MD=-1.41,95%CI(-2.55,-0.27),P=0.020。术后7d:I^(2)=0%,P=0.870;MD=-0.89,95%CI(-1.68,-0.09),P=0.030];2组患者术后48h引流量比较,差异无统计学意义[I^(2)=88%,P=0.003;MD=-82.88,95%CI(-171.30,5.55),P=0.070];共2项研究涉及术后隐性失血量的比较,结果均显示术后7d时试验组术后隐性失血量小于对照组,但其中1项研究的结果显示术后3d、5d时2组患者术后隐性失血量的差异均无统计学意义。证据质量评价结果显示,膝关节疼痛VAS评分、膝关节肿胀情况的证据质量为中,隐性失血量、术后48h引流量的证据质量为极低。结论:在TKA术后应用芒硝外敷,可以有效减轻术后早期膝关节肿痛,其疗效优于常规冰敷。

Objective:To systematically review the clinical efficacy of external application of mirabilite for relieving early knee swelling and pain after total knee arthroplasty(TKA).Methods:All the randomized controlled trial(RCT)articles about the clinical efficacy of con-ventional ice compress(control group)versus external application of mirabilite alone or conventional ice compress combined with external application of mirabilite(experimental group)for relieving early knee swelling and pain after TKA included from database establishing to April 2021 were retrieved from Chinese Biomedical Literature Database,W anfang Database,China National Knowledge Internet,Vip Data-base,Cochrane Library,Web of Science,PubMed and Embase through computer.The articles were screened and the information was extrac-ted independently by two researchers according to the inclusion and exclusion criteria.The methodological quality of research in the articles was evaluated by using Cochrane bias risk assessment tools and the quality of evidences was evaluated by using GRADE profiler3.6 soft-ware,and a Meta-analysis was conducted by using RevMan5.4 software provided by Cochrane Collaboration.Results:Fifty-seven articles were searched out.After screening,8 Chinese articles were included in the final analysis.The results of Meta-analysis revealed that there was no statistical difference in knee pain visual analogue scale(V AS)score between the 2 groups at postoperative hour 48 and 72(postoper-ative hour48:I^(2)=0%,P=0.900;MD=-0.18,95%CI(-0.48,0.12),P=0.230.postoperative hour 72:I^(2)=0%,P=1.000,MD=-0.07,95%CI(-0.24,0.10),P=0.410).The knee pain VAS score was lower in experimental group compared to control group at postoperative day 7(I^(2)=91%,P=0.000;MD=-0.61,95%CI(-0.93,-0.28),P=0.000).The perimeter of leg at 10 cm above the knee was smaller in experimental group compared to control group at postoperative day 3 and 7(postoperative day 3:I^(2)=79%,P=0.000;MD=-1.41,95%CI(-2.55,-0.27),P=0.020.postoperative day 7:I^(2)=0%,P=0.870;MD=-0.89,95%CI(-1.68,-0.09),P=0.030).There was no statistical difference in postoperative 48-hour drainage volume between the 2 groups(I^(2)=88%,P=0.003;MD=-82.88,95%CI(-171.30,5.55),P=0.070).The postoperative hidden blood loss was compared between the 2 groups in 2 researchs,and the results showed that the postoperative hidden blood loss was less in experimental group compared to control group at postoperative day 7,while the results of one research showed that there was no statistical difference in postoperative hidden blood loss be-tween the 2 groups at postoperative day 3 and 5.The results of evidence quality evaluation showed that the evidence quality of knee pain VAS score and knee swelling was medium,while an extremely poor evidence quality was found in hidden blood loss and postoperative 48-hour drainage volume.Conclusion:External application of mirabilite can effectively relieve early knee swelling and pain after TKA,and its clinical efficacy is better than that of conventional ice compress.