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[膝状动脉栓塞术治疗膝骨关节炎继发疼痛的疗效和安全性的荟萃分析]

[A meta-analysis of the efficacy and safety of genicular artery embolization for the treatment of pain secondary to knee osteoarthritis].

作者信息

Li Y Q, Wang G G, Wang Y J, Tao T, Zhang Z Y, Zheng D, Chen Y, Jia Z Z, Zhao J W

机构信息

Department of Interventional and Vascular Surgery, the Third Affiliated Hospital of Nanjing Medical University, Changzhou Second People's Hospital, Changzhou213003, China.

Department of Orthopedics, the Third Affiliated Hospital of Nanjing Medical University, Changzhou Second People's Hospital, Changzhou213003, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2024 Dec 3;104(45):4162-4170. doi: 10.3760/cma.j.cn112137-20240825-01960.

Abstract

To assess the efficacy and safety of genicular artery embolization (GAE) in the management of pain secondary to knee osteoarthritis (KOA). Literature search was conducted on PubMed, Web of Science, Cochrane Library, Embase, and Wanfang databases to collect literatures related to KOA, GAE and therapeutic effects. The search period was from the inception of the databases to July 2024. Literature screening and data extraction were carried out independently by two researchers according to the inclusion and exclusion criteria, and the quality of the included literature was assessed using the methodological index for non-randomized studies. Data extracted included visual analog scale (VAS) scores, total western ontario and mcmaster universities osteoarthritis index (WOMAC) scores, and the incidence of adverse events, followed by a meta-analysis using STATA 15.1 software. A total of 11 papers involving 332 patients (419 knees) from 11 studies were included according to the Na-row criteria. The technical success rate was 100%. The standardized mean differences of VAS scores at 1, 3, 6, and 12 months postoperatively were -2.42(95%:-2.89--1.95), -2.44(95%:-2.94--1.93), -2.57(95%:-3.13--2.01), and -2.60(95%:-3.37--1.84), respectively, all showing decreases (all <0.001); the weighted mean difference of WOMAC total score at 1, 3, 6, and 12 months after surgery were -24.44(95%:-29.13--19.75), -28.30(95%:-31.47--25.12), -30.66(95%:-32.94--28.37), and -34.23(95%:-44.39--24.07), all showing decreases (all <0.001). The incidence of adverse events mainly included skin color changes of 16.4%(95%: 5.5%-31.0%, <0.001) and hematoma at the puncture site 3.8%(95%: 1.1%-7.6%, <0.001), with the majority being mild and self-resolving. GAE treatment for KOA secondary pain has good efficacy and safety, providing a new treatment option for KOA patients as a minimally invasive procedure.

摘要

评估膝下动脉栓塞术(GAE)治疗膝骨关节炎(KOA)继发疼痛的疗效和安全性。在PubMed、Web of Science、Cochrane图书馆、Embase和万方数据库中进行文献检索,以收集与KOA、GAE及治疗效果相关的文献。检索时间从各数据库建库至2024年7月。由两名研究人员根据纳入和排除标准独立进行文献筛选和数据提取,并使用非随机研究方法学指标评估纳入文献的质量。提取的数据包括视觉模拟量表(VAS)评分、西安大略和麦克马斯特大学骨关节炎指数(WOMAC)总分以及不良事件发生率,随后使用STATA 15.1软件进行荟萃分析。根据纳入标准,共纳入11项研究中的11篇论文,涉及332例患者(419膝)。技术成功率为100%。术后1、3、6和12个月时VAS评分的标准化均差分别为-2.42(95%置信区间:-2.89至-1.95)、-2.44(95%置信区间:-2.94至-1.93)、-2.57(95%置信区间:-3.13至-2.01)和-2.60(95%置信区间:-3.37至-1.84),均呈下降趋势(均<0.001);术后1、3、6和12个月时WOMAC总分的加权均差分别为-24.44(95%置信区间:-29.13至-19.75)、-28.30(95%置信区间:-31.47至-25.12)、-30.66(95%置信区间:-32.94至-28.37)和-34.23(95%置信区间:-44.39至-24.07),均呈下降趋势(均<0.001)。不良事件发生率主要包括皮肤颜色改变16.4%(95%置信区间:5.5%至31.0%,<0.001)和穿刺部位血肿3.8%(95%置信区间:1.1%至7.6%,<0.001),大多数为轻度且可自行缓解。GAE治疗KOA继发疼痛具有良好的疗效和安全性,作为一种微创手术为KOA患者提供了一种新的治疗选择。

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