非甾体类抗炎药物预防髋关节镜术后异位骨化有效性和安全性的Meta分析

摘要

Objective To evaluate the efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs) in preventing heterotopic ossification after hip arthroscopy.Methods Literature search was conducted in PubMed,Embase,Cochrane Library,CNKI and Wanfang data with time range from January 1973 to November 2017.Clinical case control articles on NSAIDs in preventing heterotopic ossification after hip arthroscopy were screened based on the inclusion and exclusion criteria.Meta analysis was done using RevMan 5.3 software to investigate the incidence of complications such as heterotopic ossification and gastrointestinal bleeding after hip arthroscopy in patients taking NSAIDs orally.Results Six articles were included in the study,with a total of 754 cases and 536 controls.NSAIDs reduced the incidence of heterotopic ossification after hip arthroscopy (RR =0.09,95％ CI 0.03-0.27,P ＜ 0.05).Selective COX-2 inhibitor celecoxib (RR =0.17,95％ CI 0.03-0.91,P ＜ 0.05) and PG synthase inhibitor of naproxen (RR =0.17,95％ CI 0.09-0.32,P ＜ 0.05) were also effective in preventing heterotopic ossification.There was no significant difference in the incidence of gastrointestinal complications between the cases and controls after NSAIDs prophylaxis (RR =2.17,95％ CI 0.92-5.12,P ＞ 0.05).Conclusion NSAIDs can effectively reduce the incidence of heterotopic ossification after hip arthroscopy and does not increase the incidence of postoperative gastrointestinal complications.Therefore,it is effective and safe to use NSAIDs to prevent the occurrence of heterotopic ossification after hip arthroscopy.%目的 评价非甾体类抗炎药物(NSAIDs)对髋关节镜术后异位骨化的有效性及安全性. 方法 检索PubMed、Embase、Cochrane Library、中国知网、万方等数据库,检索时间范围为1973年1月-2017年11月.根据纳入和排除标准,对NSAIDs预防髋关节镜术后异位骨化的相关临床对照研究文献进行筛选.运用RevMan 5.3软件,分析患者口服NSAIDs对髋关节镜术后异位骨化和胃肠道出血等并发症的影响. 结果 共纳入文献6篇,其中试验组754例,对照组536例.口服NSAIDs可以减少髋关节镜术后异位骨化发生率(RR =0.09,95％ CI0.03～0.27,P ＜0.05).口服NSAlDs中的塞来昔布(RR=0.17,95％CI 0.03 ～0.91,P＜0.05)和萘普生(RR=0.17,95％ CI0.09 ～0.32,P＜0.05)均可预防髋关节镜术后异位骨化的发生.口服NSAIDs后,试验组和对照组胃肠道并发症发生率差异无统计学意义(RR=2.17,95％CI 0.92～5.12,P＞0.05).结论 NSAIDs能有效降低髋关节镜术后异位骨化的发生率,并未增加术后胃肠道并发症的发生率.运用NSAIDs预防髋关节镜术后异位骨化是安全有效的.