Bolia Ioanna K, Fagotti Lorenzo, McNamara Shannen, Dornan Grant, Briggs Karen K, Philippon Marc J
Department of Hip Research, Steadman Philippon Research Institute, Vail, CO, USA.
Department of Hip Research, The Steadman Clinic, 181 W. Meadow Dr., Vail, CO, USA.
J Hip Preserv Surg. 2018 Aug 17;5(3):190-201. doi: 10.1093/jhps/hny029. eCollection 2018 Aug.
The purpose of this study was to report the proportion of venous thromboembolic events (VTE) in patients undergoing primary hip arthroscopy for femoroacetabular impingement (FAI) and present a critical overview of the literature to aid in better result interpretation. MedLine, Scopus and Web of Science databases were searched from January 2000 to March 2017. Four thousand-five-hundred and seventy-seven hip cases were included in the meta-analysis of 38 studies. The mean age of patients was 36 ± 1.8 years and the mean follow-up time was 20.6 months. The meta-analysed rate of deep vein thrombosis (DVT) in patients undergoing primary hip arthroscopy for FAI syndrome was 1.18%; 95%CI [0.8-1.74%]; The meta-analysed rate of pulmonary embolism (PE) in patients undergoing primary hip arthroscopy for FAI syndrome was 0.59%; 95%CI [0.38-0.92%]. Quality assessment was performed using the Methodological Index for Non-Randomized Studies (MINORS) criteria the Quality in Prognostic Studies (QUIPS) tool. Sensitivity analysis was conducted to assess for publication bias and its influence on the results. The corrected for publication bias proportion of DVT was 2.02%; 95%CI [1.36-2.99%]. The DVT rate was double following the correction of bias while additional types of bias were detected. Attention must be paid when considering the outcomes of observational studies to make clinical decisions. Insufficient evidence exists to support whether anti-VTE chemoprophylaxis should be administered to patients undergoing primary hip arthroscopy for FAI. Due to the life-threatening character of this complication, the results should serve as starting point to design clinical trials and establish guidelines. Until then, the application of preventive measures against VTE should be decided on a case-by-case basis.
本研究的目的是报告因股骨髋臼撞击症（FAI）接受初次髋关节镜手术患者的静脉血栓栓塞事件（VTE）发生率，并对相关文献进行批判性综述，以帮助更好地解读研究结果。检索了2000年1月至2017年3月期间的MedLine、Scopus和Web of Science数据库。38项研究的荟萃分析纳入了4577例髋关节病例。患者的平均年龄为36±1.8岁，平均随访时间为20.6个月。因FAI综合征接受初次髋关节镜手术患者的荟萃分析深静脉血栓形成（DVT）发生率为1.18%；95%置信区间[0.8 - 1.74%]；因FAI综合征接受初次髋关节镜手术患者的荟萃分析肺栓塞（PE）发生率为0.59%；95%置信区间[0.38 - 0.92%]。使用非随机研究方法学指数（MINORS）标准和预后研究质量（QUIPS）工具进行质量评估。进行敏感性分析以评估发表偏倚及其对结果的影响。校正发表偏倚后的DVT比例为2.02%；95%置信区间[1.36 - 2.99%]。校正偏倚后DVT发生率翻倍，同时检测到其他类型的偏倚。在考虑观察性研究结果以做出临床决策时必须予以关注。对于因FAI接受初次髋关节镜手术的患者是否应给予抗VTE化学预防，尚无足够证据支持。由于这种并发症具有危及生命的特性，这些结果应作为设计临床试验和制定指南的起点。在此之前，针对VTE的预防措施应根据具体情况决定。
