Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 293 Wellington Street North, Suite 110, Hamilton, ON L8L 2X2, Canada.
J Bone Joint Surg Am. 2010 Jan;92(1):48-57. doi: 10.2106/JBJS.I.00251.
As the number of studies in the literature is increasing, orthopaedic surgeons highly depend on meta-analyses as their primary source of scientific evidence. The objectives of this review were to assess the scientific quality and number of published meta-analyses on orthopaedics-related topics over time.
We conducted, in duplicate and independently, a systematic review of published meta-analyses in orthopaedics in the years 2005 and 2008 and compared them with a previous systematic review of meta-analyses from 1969 to 1999. A search of electronic databases (MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews) was performed to identify meta-analyses published in 2005 and 2008. We searched bibliographies and contacted content experts to identify additional relevant studies. Two investigators independently assessed the quality of the studies, using the Oxman and Guyatt index, and abstracted relevant data.
We included forty-five and forty-four meta-analyses from 2005 and 2008, respectively. While the number of meta-analyses increased fivefold from 1999 to 2008, the mean quality score did not change significantly over time (p = 0.067). In the later years, a significantly lower proportion of meta-analyses had methodological flaws (56% in 2005 and 68% in 2008) compared with meta-analyses published prior to 2000 (88%) (p = 0.006). In 2005 and 2008, respectively, 18% and 30% of the meta-analyses had major to extensive flaws in their methodology. Studies from 2008 with positive conclusions used and described appropriate criteria for the validity assessment less often than did those with negative results. The use of random-effects and fixed-effects models as pooling methods became more popular toward 2008.
Although the methodological quality of orthopaedic meta-analyses has increased in the past twenty years, a substantial proportion continues to show major to extensive flaws. As the number of published meta-analyses is increasing, a routine checklist for scientific quality should be used in the peer-review process to ensure methodological standards for publication.
随着文献中研究数量的增加，矫形外科医生高度依赖荟萃分析作为其主要的科学证据来源。本研究的目的是评估随着时间的推移，关于矫形外科相关主题的已发表荟萃分析的科学质量和数量。
我们重复且独立地对 2005 年和 2008 年发表的矫形外科荟萃分析进行了系统评价，并将其与 1969 年至 1999 年的先前系统评价进行了比较。通过检索电子数据库（MEDLINE、EMBASE 和 Cochrane 系统评价数据库），我们检索了 2005 年和 2008 年发表的荟萃分析。我们检索了参考文献并联系了内容专家，以确定其他相关研究。两位研究者独立使用 Oxman 和 Guyatt 指数评估研究质量，并提取相关数据。
我们分别纳入了 2005 年和 2008 年的 45 项和 44 项荟萃分析。虽然 2008 年的荟萃分析数量是 1999 年的五倍，但随着时间的推移，其质量评分并没有显著变化（p = 0.067）。在较晚的几年中，与 2000 年之前发表的荟萃分析（88%）相比，有方法学缺陷的荟萃分析比例显著降低（56%在 2005 年和 68%在 2008 年）（p = 0.006）。2005 年和 2008 年分别有 18%和 30%的荟萃分析在方法学上存在重大或广泛缺陷。与得出阴性结果的荟萃分析相比，得出阳性结论的荟萃分析在有效性评估中使用和描述适当标准的情况较少。2008 年，随机效应和固定效应模型作为汇总方法的使用变得更加流行。
尽管过去二十年来矫形外科荟萃分析的方法学质量有所提高，但仍有相当大的一部分存在重大或广泛的缺陷。随着发表的荟萃分析数量的增加，在同行评审过程中应使用科学质量常规检查表，以确保发表的方法学标准。
