抗生素骨水泥联合负压封闭引流对糖尿病足溃疡临床疗效的荟萃分析

Effect of antibiotic bone cement combined with vacuum sealing drainage for diabetic foot ulcers:a meta-analysis

目的通过Meta分析方法对抗生素骨水泥联合负压封闭引流治疗糖尿病足溃疡的临床疗效进行系统评价,以期提供循证医学依据。方法计算机检索中国知网、万方、维普、中国生物医学文献数据库及Pubmed、The Cochrane Library、Web of Science、Embase、Clinical Trials数据库,筛选抗生素骨水泥联合负压封闭引流治疗糖尿病足溃疡的临床随机对照试验,检索时间范围为建库至2023年3月。利用RevMan 5.4软件对所纳入研究进行荟萃分析。结果纳入12篇文献,共789例患者,其中试验组399例,对照组390例。由于治疗方式的特殊性,盲法实施难度较大,故存在一定的偏倚。荟萃分析结果显示,相较于单纯应用负压封闭引流治疗,抗生素骨水泥联合负压封闭引流治疗糖尿病足溃疡创面愈合时间短(MD=-8.97,95%CI:-11.64~-6.29,P<0.001),有效率高(RR=1.25,95%CI:1.14~1.37,P<0.001),住院时间短(MD=-7.94,95%CI:-11.21~-4.66,P<0.001),手术次数少(MD=-1.90,95%CI:-2.97~-0.82,P<0.001),细菌转阴时间短(MD=-5.00,95%CI:-5.26~-4.73,P<0.001)。结论抗生素骨水泥联合负压封闭引流治疗糖尿病足溃疡较单纯应用负压封闭引流具有显著优势,但由于部分纳入文献质量偏低,结果可能存在差异,需要大量高质量文献加以验证。

Objective To assess the clinical efficacy of antibiotic bone cement combined with vacuum sealing drainage in the treatment of diabetic foot ulcers,and to provide basis of evidence-based medicine.Methods A computerized literature search in CNKI,Wanfang,Vipshop,China Biomedical Literature,Pubmed,The Cochrane Library,and Web of Science,Embase,Clinical Trials databases was performed,screened clinical randomized controlled trials of antibiotic bone cement combined with vacuum sealing drainage for the treatment of diabetic foot.The retrieval time was from the time of database establishment to March 2023.Meta-analysis of the included studies was performed using RevMan 5.4 software.Results A total of 12 studies with 789 patients were included,including 399 cases in thetrial group and 390 cases in the control group.Due to the specificity of the treatment modality,it was difficult to implement the blinded method,so there was some bias.Meta-analysis results showed that compared to patients using vacuum sealing drainage alone for treatment,the time of wound healing was shorter(MD=-8.97,95%CI:-11.64--6.29,P<0.001),the efficiency was better(RR=1.25,95%CI:1.14-1.37,P<0.001),the length of hospital stay was less(MD=-7.94,95%CI:-11.21--4.66,P<0.001),the number of surgical procedures decreased(MD=-1.90,95%CI:-2.97--0.82,P<0.001),the time of bacterial negative conversion was shorter(MD=-5.00,95%CI:-5.26--4.73,P<0.001)in patients using antibiotic bone cement combined with vacuum sealing drainage.Conclusion The combination of antibiotic bone cement and vacuum sealing drainage for the treatment of diabetic foot has significant advantages over the use of vacuum sealing drainage alone,but due to the low quality of some of the included literature,the results may vary,and therefore a large amount of high-quality literature is needed to verify the above conclusions.