【摘要】 背景:近年来全膝关节置换术的数量急剧上升,但加速康复围术期管理仍未全面开展。目的:采用meta分析比较加速康复围术期管理与传统康复方法对全膝关节置换术临床疗效的影响。方法:计算机检索PubMed、Medline、CochraneLibrary、Cochrane协作网肌骨组专业试验数据库、中国生物医学文献数据库(CBM),手工检索中文骨科文献,收集全膝关节置换术采用加速康复围术期管理与传统康复方法比较的临床试验。对纳入本研究的文献采用RevMan 5.1软件进行meta分析。结果:两组的住院时间(WMD=-5.71,95%CI:-8.32～-3.09,P<0.01)、住院治疗费用(WMD=-1.97,95%CI:-2.50～-1.44,P<0.01)、术中出血量(WMD=-125.95,95%CI:-133.61～-118.28,P<0.01)、术后疼痛程度(WMD=-2.83,95%CI:-3.14～-2.52,P<0.01)、术后2周膝关节屈曲活动度(WMD=15.27,95%CI:5.57～24.97,P<0.01)、术后6个月膝关节屈曲活动度(WMD=9.01,95%CI:2.50～15.53,P<0.01)及术后6个月膝关节HSS评分(WMD=2.53,95%CI:1.51～3.55,P<0.01)均存在统计学差异。两组的输血率(RR=0.29,95%CI:0.07～1.21,P=0.09)、深静脉血栓发病率(RR=0.67,95%CI:0.48～0.94,P=0.02)及术后2周的HSS评分(WMD=12.28,95%CI:-2.88～27.43,P=0.11)无统计学差异。结论:全膝关节置换术加速康复围术期管理与传统康复方法相比,住院时间较短、治疗费用较低、术后屈曲角度较理想、术后6个月关节功能评分较高,而两种方法在输血率、深静脉血栓发病率及术后2周膝关节功能评分上无统计学差异。更多还原

【Abstract】 Background: In recent years, total knee arthroplasty(TKA) has increased sharply, but the perioperative manage-ment of enhanced recovery has not been fully carried out. Objective:To compare the clinical therapeutic effect of traditionalrecovery and enhanced recovery after TKA with meta-analysis. Methods:Computer was used to searched the PubMed, Med-line, Cochrane Library, Cochrane Bone and Muscle Group Specialised Register and CBM, and Chinese literatures weresearched by manual retrieval to identify clinical trials on the comparison of the outcome of traditional recovery and enhancedrecovery in TKA. Cochrane Collaboration’s RevMan 5.1 was performed for data analysis. Results:Length of stay(WMD=-5.71, 95%CI:-8.32～-3.09, P<0.01), medical cost(WMD=-1.97, 95%CI:-2.50～-1.44, P<0.01), intraoperative blood loss(WMD=-125.95, 95%CI:-133.61～-118.28, P<0.01), pain score(WMD=-2.83, 95%CI:-3.14～-2.52, P<0.01) significantlydecreased in enhanced recovery group, while range of motion(ROM) at 2 weeks after surgery(WMD=15.27, 95%CI: 5.57～24.97, P<0.01), ROM at 6 months after surgery(WMD=9.01, 95%CI: 2.50～15.53, P<0.01) and HSS score at 6 months aftersurgery(WMD=2.53, 95%CI: 1.51～3.55, P<0.01) significantly increased in enhanced recovery group. There were no signifi-cant differences in the transfusion rate(RR=0.29, 95%CI: 0.07～1.21, P=0.09), incidences of DVT(RR=0.67, 95%CI: 0.48～0.94, P=0.02) and HSS score at 2 weeks after surgery(WMD=12.28, 95%CI:-2.88～27.43, P=0.11) between two groups.Conclusions:Compared with traditional recovery during TKA, enhanced recovery can reduce length of stay and medical cost andincrease ROM and HSS score at 6 months after surgery. No statistical difference was found in transfusion rate, incidences ofDVT or HSS score at 2 weeks after surgery between them.更多还原