Jiang Wei, Zhu Ting-Biao
Department of Orthopaedics, Traditional Chinese Medicine Hospital of Pingshan, Yibin 645350, Sichuan Province, China.
Department of Orthopaedics, The First People's Hospital of Qujing, Qujing 655099, Yunnan Province, China.
World J Orthop. 2024 May 18;15(5):469-476. doi: 10.5312/wjo.v15.i5.469.
Intertrochanteric fracture of the femur occurs mostly among older people, and seriously affects daily life and quality of life. At present, physical intervention, drug treatment, routine intervention and rehabilitation training are widely used for prevention of side effects, but it is still inconclusive which intervention has the best effect.
To compare the effects of new intervention measures for preventing side effects of artificial joint replacement.
We searched the Chinese and English literatures for comparative studies on the prevention of side effects of new interventions for artificial joint replacement from July 2013 to June 2023 in China HowNet, PubMed, Wanfang, Weipu and other databases. Study quality was evaluated by improved Jadad scoring standard, and the effects of different interventions on preventing different complications were analyzed by meta-analysis of evidence-based medicine with Review Manager 5.0 software.
Ten articles, including 869 cases, were finally included. The preventive effects of different interventions on the side effects of artificial joint replacement were studied, and valid data were extracted. There were two articles on the preventive effects of drug intervention, four on comparison of the preventive effects of combined and single interventions, and three on the preventive effects of physical intervention, rehabilitation training and routine intervention. Meta-analysis showed that the preventive effect of rivaroxaban was significantly better than low molecular weight heparin calcium [mean difference (MD) = -0.16, 95%CI: -0.28 to -0.04, < 0.05]. The effect of combined intervention was significantly better than that of single intervention (MD = -0.08, 95%CI: -0.16 to -0.01, < 0.001). Physical intervention was significantly better than routine intervention and rehabilitation training (MD = 0.26, 95%CI: 0.16-0.36, < 0.001).
Rivaroxaban combined with rehabilitation training is preferred for preventing deep vein thrombosis after artificial joint replacement. In the prevention of pulmonary embolism, rivaroxaban drug intervention is given priority. The effect of combined intervention is better than that of single intervention.
股骨粗隆间骨折多见于老年人，严重影响日常生活及生活质量。目前，物理干预、药物治疗、常规干预及康复训练广泛应用于预防其副作用，但哪种干预效果最佳仍尚无定论。
比较人工关节置换副作用预防新干预措施的效果。
于2013年7月至2023年6月，在中国知网、PubMed、万方、维普等数据库检索人工关节置换新干预措施预防副作用的比较研究。采用改良Jadad评分标准评价研究质量，运用RevMan 5.0软件进行循证医学Meta分析，分析不同干预措施预防不同并发症的效果。
最终纳入10篇文献，共869例。研究人工关节置换不同干预措施预防副作用的效果，提取有效数据。其中关于药物干预预防效果的文献2篇，联合与单一干预预防效果比较的文献4篇，物理干预、康复训练及常规干预预防效果的文献3篇。Meta分析结果显示，利伐沙班预防效果显著优于低分子肝素钙[均差(MD)=-0.16，95%CI：-0.28至-0.04，P<0.05]。联合干预效果显著优于单一干预(MD=-0.08，95%CI：-0.16至-0.01，P<0.001)。物理干预显著优于常规干预及康复训练(MD=0.26，95%CI：0.16-0.36，P<0.001)。
人工关节置换后预防深静脉血栓形成，首选利伐沙班联合康复训练。预防肺栓塞时，优先给予利伐沙班药物干预。联合干预效果优于单一干预。
