van der Velden C A, Tolk J J, Janssen R P A, Reijman M
Máxima Medical Centre, Dominee Theodor Fliednerstraat 1, Eindhoven, Noord-Brabant 5631 BM, The Netherlands.
Erasmus MC, University Medical Centre, Rotterdam, The Netherlands.
Bone Joint J. 2017 May;99-B(5):566-576. doi: 10.1302/0301-620X.99B5.BJJ-2016-1064.R1.
The aim of this study was to assess the current available evidence about when patients might resume driving after elective, primary total hip (THA) or total knee arthroplasty (TKA) undertaken for osteoarthritis (OA).
In February 2016, EMBASE, MEDLINE, Web of Science, Scopus, Cochrane, PubMed Publisher, CINAHL, EBSCO and Google Scholar were searched for clinical studies reporting on 'THA', 'TKA', 'car driving', 'reaction time' and 'brake response time'. Two researchers (CAV and JJT) independently screened the titles and abstracts for eligibility and assessed the risk of bias. Both fixed and random effects were used to pool data and calculate mean differences (MD) and 95% confidence intervals (CI) between pre- and post-operative total brake response time (TBRT).
A total of 19 studies were included. The assessment of the risk of bias showed that one study was at high risk, six studies at moderate risk and 12 studies at low risk. Meta-analysis of TBRT showed a MD decrease of 25.54 ms (95% CI -32.02 to 83.09) two weeks after right-sided THA, and of 18.19 ms (95% CI -6.13 to 42.50) four weeks after a right-sided TKA, when compared with the pre-operative value.
The TBRT returned to baseline two weeks after a right-sided THA and four weeks after a right-sided TKA. These results may serve as guidelines for orthopaedic surgeons when advising patients when to resume driving. However, the advice should be individualised. Cite this article: 2017;99-B:566-76.
本研究旨在评估目前关于骨关节炎（OA）患者在接受择期初次全髋关节置换术（THA）或全膝关节置换术（TKA）后何时可以恢复驾驶的现有证据。
2016年2月，检索了EMBASE、MEDLINE、科学网、Scopus、Cochrane、PubMed出版商、CINAHL、EBSCO和谷歌学术等数据库，以查找报告“THA”“TKA”“汽车驾驶”“反应时间”和“制动反应时间”的临床研究。两名研究人员（CAV和JJT）独立筛选标题和摘要以确定其是否符合条件，并评估偏倚风险。采用固定效应和随机效应模型汇总数据，并计算术前和术后总制动反应时间（TBRT）之间的平均差异（MD）和95%置信区间（CI）。
共纳入19项研究。偏倚风险评估显示，1项研究为高风险，6项研究为中度风险，12项研究为低风险。TBRT的荟萃分析显示，与术前值相比，右侧THA术后两周TBRT平均降低25.54毫秒（95%CI -32.02至83.09），右侧TKA术后四周TBRT平均降低18.19毫秒（95%CI -6.13至42.50）。
右侧THA术后两周和右侧TKA术后四周，TBRT恢复至基线水平。这些结果可为骨科医生在告知患者何时恢复驾驶时提供指导。然而，建议应个体化。引用本文：2017；99-B：566-76。
