Department of Orthopedics, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, China; University of Electronic Science and Technology of China, Chengdu, China.
Department of Rehabilitation, Jinniu District People's Hospital of Chengdu, Chengdu, China.
Ann Palliat Med. 2021 Oct;10(10):10467-10474. doi: 10.21037/apm-21-2231.
To investigate the preventive effect of elastic stockings on deep vein thrombosis (DVT) after orthopedic surgery by literature search and meta-analysis.
PubMed, Embase and Cochrane were selected as the search database platforms to search the literature of randomized controlled trials related to elastic stockings and DVT published from 2008 to date. Revman 5.3.5 software was used for statistical analysis of the data to obtain forest and funnel plots.
In this study, 90 studies were initially screened and 7 were finally included, covering a total of 3,116 patients. Meta-analysis showed that the 7 studies had statistical heterogeneity (I2=32%, P=0.18), so a random effect model was used. The obtained statistic was [odds ratio (OR) =0.59, 95% confidence interval (CI): (0.34, 1.03)], the statistical effect size was Z=1.84, P=0.07, and the difference was not statistically significant, so a stepwise sensitivity analysis was performed by the exclusion method. One study was excluded, and the remaining 6 showed homogeneity (I2=0%, P=0.46). They were analyzed by subgroup according to the type of operation: ankle surgery or hip and knee arthroplasty. The internal literatures of each subgroup were homogeneous: ankle surgery subgroup (I2=0%, P=0.43), hip and knee arthroplasty subgroup (I2=0%, P=0.88). Therefore, fixed effect mode analysis was used, and the effect size of elastic stockings after ankle surgery was Z=3.65, P=0.0003, while the effect size of elastic stockings in the hip and knee arthroplasty subgroup was Z=1.23, P=0.22.
Elastic stockings had an obvious preventive effect on DVT in patients undergoing ankle surgery, but not in patients undergoing lumbar, knee or spinal surgery. It is necessary to combine anticoagulant drugs and other physical therapies to prevent DVT.
通过文献检索和荟萃分析，研究弹力袜对骨科手术后深静脉血栓形成（DVT）的预防作用。
选择 PubMed、Embase 和 Cochrane 作为检索数据库平台，检索 2008 年至今发表的与弹力袜和 DVT 相关的随机对照试验文献。使用 Revman 5.3.5 软件对数据进行统计分析，得出森林图和漏斗图。
本研究初筛 90 项研究，最终纳入 7 项研究，共纳入 3116 例患者。Meta 分析显示 7 项研究存在统计学异质性（I2=32%，P=0.18），故采用随机效应模型。获得的统计学量为[比值比（OR）=0.59，95%置信区间（CI）：（0.34，1.03）]，Z 值为 1.84，P=0.07，差异无统计学意义，故采用排除法进行逐步敏感性分析。排除 1 项研究后，其余 6 项研究同质性良好（I2=0%，P=0.46）。根据手术类型进行亚组分析：踝关节手术或髋膝关节置换术。各亚组内文献同质：踝关节手术亚组（I2=0%，P=0.43），髋膝关节置换术亚组（I2=0%，P=0.88）。因此，采用固定效应模式分析，踝关节手术后弹力袜的效果大小为 Z=3.65，P=0.0003，而髋膝关节置换术亚组的效果大小为 Z=1.23，P=0.22。
弹力袜对踝关节手术患者的 DVT 有明显的预防作用，但对腰椎、膝关节或脊柱手术患者无明显预防作用。需要联合抗凝药物和其他物理疗法预防 DVT。
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