Zhu Shibai, Song Yi, Chen Xi, Qian Wenwei
Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China.
Department of Endocrinology and Metabolism, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.
J Orthop Surg Res. 2018 Apr 10;13(1):79. doi: 10.1186/s13018-018-0785-2.
Chinese herbal medicine has traditionally been considered to promote blood circulation to remove obstruction in the channels and clear pathogenic heat to drain dampness effects. We conducted this meta-analysis to evaluate its benefits for the prevention of deep venous thrombosis (DVT) after lower extremity orthopedic surgery.
Relevant, published studies were identified using the following keywords: lower extremity orthopedic surgery, arthroplasty, joint replacement, fracture, traditional Chinese and western medicine, Chinese herbal medicine, deep venous thrombosis (DVT), and Venous thromboembolism (VTE). The following databases were used to identify the literature consisting of RCTs with a date of search of 31 May 2017: PubMed, Cochrane Library, Web of knowledge, the Chinese National Knowledge Infrastructure Database, the Chongqing VIP Database, the Chinese Biomedical Database, and the Wanfang Database (including three English and four Chinese databases). All relevant data were collected from studies meeting the inclusion criteria. The outcome variables were the incidence rate of DVT, activated partial thromboplastin time (APTT), prothrombin time (PT), and D-dimer; subcutaneous hematoma; and other reported outcomes. RevMan5.2. software was adopted for the meta-analysis.
A total of 20 published studies (1862 cases) met the inclusion criteria. The experimental group, 910 patients (48.87%), received the Chinese herbal medicine or traditional Chinese and western medicine for prevention of DVT; the control group, 952 patients (51.13%), received the standard western treatment. The meta-analysis showed that traditional Chinese and western medicine therapy reduced the incidence rates of DVT significantly when compared with controls (risk ratio [RR] = 0.40; 95% CI, 0.30 to 0.54; P < 0.00001), and the D-dimer was lower in the experimental group (P = 0.01). Besides, the incidence rate of subcutaneous hematoma was lower in the experimental group (P < 0.0001). However, no significant difference was found in the PT (P = 0.98) and APTT (P = 0.75) in two groups. No serious adverse events were reported.
Traditional Chinese and western medicine therapy may be a safe, effective prevention modality for DVT after lower extremity orthopedic surgery. Further rigorously designed, randomized trials are warranted.
传统上认为中药具有活血化瘀、清热利湿的功效。我们进行了这项荟萃分析，以评估其在预防下肢骨科手术后深静脉血栓形成（DVT）方面的益处。
使用以下关键词检索相关的已发表研究：下肢骨科手术、关节成形术、关节置换、骨折、中西医结合、中药、深静脉血栓形成（DVT）和静脉血栓栓塞（VTE）。使用以下数据库检索截至2017年5月31日的随机对照试验文献：PubMed、Cochrane图书馆、Web of knowledge、中国国家知识基础设施数据库、重庆维普数据库、中国生物医学数据库和万方数据库（包括3个英文数据库和4个中文数据库）。从符合纳入标准的研究中收集所有相关数据。结局变量为DVT发生率、活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）和D-二聚体；皮下血肿；以及其他报告的结局。采用RevMan5.2软件进行荟萃分析。
共有20项已发表研究（1862例）符合纳入标准。实验组910例患者（48.87%）接受中药或中西医结合治疗预防DVT；对照组952例患者（51.13%）接受标准西医治疗。荟萃分析表明，与对照组相比，中西医结合治疗显著降低了DVT的发生率（风险比[RR]=0.40；95%可信区间，0.30至0.54；P<0.00001），且实验组的D-二聚体较低（P=0.01）。此外，实验组皮下血肿的发生率较低（P<0.0001）。然而，两组的PT（P=0.98）和APTT（P=0.75）无显著差异。未报告严重不良事件。
中西医结合治疗可能是下肢骨科手术后预防DVT的一种安全、有效的方法。有必要进一步进行设计严谨的随机试验。
