Constantinescu David S, Campbell Michael P, Moatshe Gilbert, Vap Alexander R
Department of Orthopedic Surgery, Virginia Commonwealth University, Richmond, Virginia, USA.
Oslo Sports Trauma Research Center, Oslo, Norway.
Orthop J Sports Med. 2019 Apr 16;7(4):2325967119838873. doi: 10.1177/2325967119838873. eCollection 2019 Apr.
The effects of perioperative nonsteroidal anti-inflammatory drugs (NSAIDs) on soft tissue healing in humans have yet to be established.
To systematically review the literature addressing the effects of perioperative NSAID administration on soft tissue healing and clinical patient outcomes.
Systematic review; Level of evidence, 3.
This review study was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. A review of the literature regarding the existing evidence for clinical effects of NSAID use on soft tissue healing was performed through use of the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (1980 to present), and MEDLINE. Inclusion criteria for articles were as follows: outcome studies after soft tissue (ligament, meniscus, tendon, muscle) healing after surgical procedure with perioperative NSAID administration, at least 1 year of follow-up, English language, and human participants.
A total of 466 studies were initially retrieved, with 4 studies satisfying all inclusion criteria. Among the surgical procedures reported, 93% of the patients (4144/4451) underwent anterior cruciate ligament (ACL) reconstruction, 3% (120/4451) underwent rotator cuff repair, 3% (155/4451) underwent Bankart shoulder repair, and 1% (32/4451) underwent meniscal repair. The reported surgical failure rate among patients administered NSAIDs was 3.6% (157/4360). The reported surgical failure rate among control participants not given NSAIDs was 3.7% (147/3996). NSAID use showed no statistically significant effect on need for reoperation in meniscal repair ( = .99), ACL reconstruction ( = .8), and Bankart repair ( = .8) compared with no NSAID administration. Celecoxib administration had a significantly higher rate of retear (37%) after rotator cuff repair compared with ibuprofen (7%) ( = .009).
Insufficient data are available to definitively state the effects of perioperative NSAIDs on soft tissue healing. Use of NSAIDs should be considered on a case-by-case basis and may not affect healing rates following either meniscal, ACL, rotator cuff, or Bankart repair. However, celecoxib (a selective COX-2 inhibitor) may inhibit tendon-to-bone healing in rotator cuff repair. Further research through clinical trials is required to fully determine whether NSAIDs have an adverse effect on soft tissue healing.
围手术期非甾体抗炎药（NSAIDs）对人体软组织愈合的影响尚未明确。
系统回顾关于围手术期使用NSAIDs对软组织愈合及临床患者预后影响的文献。
系统回顾；证据等级，3级。
本回顾性研究按照PRISMA（系统评价与Meta分析优先报告条目）声明进行。通过使用Cochrane系统评价数据库、Cochrane对照试验中央注册库、PubMed（1980年至今）和MEDLINE，对NSAIDs用于软组织愈合临床效果的现有证据相关文献进行回顾。纳入文章的标准如下：围手术期使用NSAIDs的手术操作后软组织（韧带、半月板、肌腱、肌肉）愈合的结局研究，至少1年的随访，英文文献，以及人类受试者。
最初检索到466项研究，其中4项研究符合所有纳入标准。在报告的手术操作中，93%的患者（4144/4451）接受了前交叉韧带（ACL）重建，3%（120/4451）接受了肩袖修复，3%（155/4451）接受了Bankart肩关节修复，1%（32/4451）接受了半月板修复。使用NSAIDs的患者报告的手术失败率为3.6%（157/4360）。未使用NSAIDs的对照参与者报告的手术失败率为3.7%（147/3996）。与未使用NSAIDs相比，NSAIDs的使用在半月板修复（P = 0.99）、ACL重建（P = 0.8）和Bankart修复（P = 0.8）中对再次手术需求无统计学显著影响。与布洛芬（7%）相比，塞来昔布用于肩袖修复后的再撕裂率显著更高（37%）（P = 0.009）。
现有数据不足以明确围手术期NSAIDs对软组织愈合的影响。NSAIDs的使用应根据具体情况考虑，可能不会影响半月板、ACL、肩袖或Bankart修复后的愈合率。然而，塞来昔布（一种选择性COX - 2抑制剂）可能会抑制肩袖修复中肌腱与骨的愈合。需要通过临床试验进行进一步研究，以全面确定NSAIDs是否对软组织愈合有不良影响。
