Vavken Patrick, Dorotka Ronald
Department of Orthopedic Surgery, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA.
Clin Orthop Relat Res. 2009 Oct;467(10):2723-35. doi: 10.1007/s11999-009-0765-2. Epub 2009 Feb 28.
Meta-analyses are important evaluations in orthopaedic surgery, not only to create clinical guidelines, but also because their findings are included in public health and health policy decision making. However, with increasing numbers of meta-analyses, discordant and frankly conflicting conclusions have been reported. We searched for conflicting meta-analyses, ie, those arriving at different conclusions despite following the same research question, identified potential reasons for these differences, and assessed the statistical significance and clinical importance of differences. We identified conflicting meta-analyses on graft choice in ACL reconstruction and the use of hyaluronic acid. We found significant differences in individual results only for meta-analyses on hyaluronic acid, but the 95% confidence intervals of the magnitude of differences included values as much as 40% for ACL meta-analyses. However, our findings suggest most conflicts derive from differences in the interpretation of pooled results rather than in the actual results. Thus conclusions and interpretations from meta-analyses should be scrutinized as critically as those from any other type of study and subjected to reassessment if deemed necessary.
荟萃分析在骨科手术中是重要的评估手段，不仅用于制定临床指南，还因其研究结果被纳入公共卫生和卫生政策决策过程。然而，随着荟萃分析数量的增加，出现了不一致甚至明显相互矛盾的结论。我们搜索了相互矛盾的荟萃分析，即那些尽管研究问题相同但得出不同结论的分析，确定了这些差异的潜在原因，并评估了差异的统计学意义和临床重要性。我们识别出了关于前交叉韧带重建中移植物选择和透明质酸使用的相互矛盾的荟萃分析。我们发现，仅在关于透明质酸的荟萃分析中，个体结果存在显著差异，但在前交叉韧带荟萃分析中，差异幅度的95%置信区间包含高达40%的值。然而，我们的研究结果表明，大多数冲突源于对合并结果的解释差异，而非实际结果的差异。因此，对荟萃分析的结论和解释应像对任何其他类型研究的结论和解释一样进行严格审查，并在必要时进行重新评估。
