目的 通过Meta分析评估冷疗对人工全膝关节置换术(TKA)术后早期出血、活动、疼痛及肿胀度方面的有效性，为TKA患者的快速康复提供参考。方法 检索中国知网、万方数据库、维普网、PubMed、Cochrane Library及EMbase数据库，筛选2000年1月-2020年9月公开发表的TKA术后应用冷疗及其他常规治疗的随机对照研究(RCTs)，结局指标为术后早期引流量、膝关节活动度、视觉模拟评分(VAS)及膝关节髌骨上缘周径差值，对符合标准的文献进行数据提取，并采用Review Manager 5。4进行Meta分析。结果 共纳入8项RCTs，共669例患者，其中冷疗组348例，对照组321例。Meta分析显示，冷疗组术后24 h引流量明显低于对照组，差异有统计学意义[MD=-51。32，95％CI=(-66。69，-35。95)，P＜0。000 01];冷疗组与对照组术后24 h膝关节活动度比较，差异无统计学意义[MD=5。60，95％CI=(-7。33，18。54)，P=0。40];冷疗组与对照组术后24 h VAS评分[MD=-0。76，95％CI=(-1。80，0。28)，P=0。15]及术后 72 h VAS 评分[MD=-0。31，95％CI=(-1。20，0。58)，P=0。49]比较，差异均无统计学意义;冷疗组与对照组术后24 h膝关节髌骨上缘周径差值[MD=-1。08，95％CI=(-2。23，0。07)，P=0。07]及术后48 h膝关节髌骨上缘周径差值[MD=-1。26，95％CI=(-3。48，0。97)，P=0。27]比较，差异均无统计学意义。结论 TKA术后应用冷疗能有效减少术后24 h引流量，但对术后早期膝关节活动范围、疼痛及肿胀度方面无明显作用。
Meta-analysis of the Effectiveness of Early Application of Cryotherapy After Total Knee Arthroplasty
Objective To evaluate the effectiveness of cryotherapy in early bleeding,activity,pain and swelling after total knee arthroplasty(TKA)using a meta-analysis,so as to provide a reference for the rapid rehabilitation of patients undergoing TKA.Methods The randomized controlled trials(RCTs)of applying cryotherapy and other conventional treatment after TKA published from January 2000 to September 2020 were searched from the China National Knowledge Internet(CNKI),Wanfang Database,VIP Database,PubMed,Cochrane Library and Embase database.The outcome measures included early drainage volume,knee range of motion,Visual Analogue Scale(VAS)score and the difference in peripheral diameter of the upper edge of the patella of the knee joint after surgery.The data were extracted from the articles meeting the criteria and analyzed using Review Manager 5.4.Results A total of 669 patients from 8 RCTs were included,with 348 patients in the cryotherapy group and 321 patients in the control group.Meta-analysis showed that:① The drainage volume 24 h after surgery in the cryotherapy group was significantly lower than that in the control group[MD=-51.32,95％CI(-66.69,-35.95),P＜0.000 01],with a statistically significant difference;② The knee range of motion 24 h after surgery showed no significant difference between the cryotherapy group and the control group[MD=5.60,95％CI(-7.33,18.54),P=0.40];③ In the cryotherapy group,the VAS score 24 h after surgery[MD=-0.76,95％CI(-1.80,0.28),P=0.15]and the VAS score 72 h after surgery[MD=-0.31,95％CI(-1.20,0.58),P=0.49]presented no statistically significant differences from those in the control group;④ Compared with the control group,no statistically significant differences were found in the difference in peripheral diameter of the upper edge of the patella of the knee joint 24 h after surgery[MD=-1.08,95％CI(-2.23,0.07),P=0.07]or the difference in peripheral diameter 48 h after surgery[MD=-1.26,95％CI(-3.48,0.97),P=0.27].Conclusion Cryotherapy after TKA can effectively reduce the drainage volume 24 h after surgery,but it has no significant effect on the range of motion,pain and swelling of the knee joint in the early stage after surgery.
万方数据
维普
