髋关节置换术后引流与术后感染相关性的荟萃分析

doi:10.3877/cma.j.issn.1674-134X.2021.03.007

目的

评价髋关节置换术后引流与否与术后感染相关性。

方法

检索PUBMED、Cochrane图书馆、中国知网数据库、重庆维普中文科技期刊数据库和万方数据库从建库至2019年12月31日髋关节置换术后引流与不引流的高质量随机对照试验，筛选结局指标中包含引流组和不引流组术后感染率的研究进行分析。偏倚风险评价应用Cochrane评价员手册。应用RevMan 5.3软件对术后感染率指标进行Meta分析。

结果

符合纳入标准的文献共15篇。Meta分析结果显示，引流组和不引流组比较，术后感染率差异无统计学意义[相对危险度(RR)＝1.04，95%置信区间(CI)(0.64，1.69)，P＝0.87]。

结论

髋关节置换术后放置引流管与不引流相比并不能降低术后感染率。需要更多多中心、大样本随机对照试验来获取最佳证据。

关键词: 关节成形术, 置换, 髋, 引流术, 外科伤口感染, Meta分析

Objective

To evaluate the correlation between drainage and postoperative infection after hip arthroplasty.

Methods

PUBMED, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure, the Chongqing VIP database and Wanfang Data from the inception of each database up to 31 December 2019 were electronically searched. High-quality randomized clinical trials (RCTs) of drainage and non-drainage after hip arthroplasty, which evaluated indicators of postoperative infection were included. The Cochrane risk of bias tool was used to assess the risk of bias. The Cochrane Collaboration’s RevMan5.3 software was used for meta-analysis.

Results

Fifteen studies were included and made a meta-analysis. The meta-analysis results showed no significant difference in postoperative infection rate between the drainage group and the non-drainage group[ relative risk (RR)=1.04, 95% confidence interval (CI) (0.64, 1.69), P=0.87].

Conclusion

Drainage after hip arthroplasty did not reduce the postoperative infection rate compared with the non-drainage group. More central, large sample RCTs are needed to obtain the best evidence.

Key words: Arthroplasty, replacement, hip, Drainage, Surgical wound infection, Meta-analysis

图1 文献筛选流程图

表1 纳入研究的基本特征

纳入研究	发表时间	引流组例数	不引流组例数	随访时间
Beer ^[9]	1991	12	12	3个月
Murphy ^[14]	1993	18	19	10 d
Ritter ^[15]	1994	78	62	出院
Ovadia ^[16]	1997	18	12	出院
Kim ^[18]	1998	48	48	15个月
Crevoisier ^[17]	1998	33	33	出院
Niskanen ^[19]	2000	27	31	2个月
Widman ^[20]	2002	10	12	未提及
Gonzalez ^[21]	2004	53	51	3个月
Johansson ^[23]	2005	54	51	2个月
Walmsley ^[22]	2005	282	295	36个月
Dora ^[2]	2007	50	50	12个月
Strahovnik ^[8]	2010	97	42	3个月
Cheung ^[24]	2010	52	48	12个月
Kleinert ^[25]	2012	40	40	3个月

表1 纳入研究的基本特征

纳入研究	发表时间	引流组例数	不引流组例数	随访时间
Beer ^[9]	1991	12	12	3个月
Murphy ^[14]	1993	18	19	10 d
Ritter ^[15]	1994	78	62	出院
Ovadia ^[16]	1997	18	12	出院
Kim ^[18]	1998	48	48	15个月
Crevoisier ^[17]	1998	33	33	出院
Niskanen ^[19]	2000	27	31	2个月
Widman ^[20]	2002	10	12	未提及
Gonzalez ^[21]	2004	53	51	3个月
Johansson ^[23]	2005	54	51	2个月
Walmsley ^[22]	2005	282	295	36个月
Dora ^[2]	2007	50	50	12个月
Strahovnik ^[8]	2010	97	42	3个月
Cheung ^[24]	2010	52	48	12个月
Kleinert ^[25]	2012	40	40	3个月

图2 纳入研究的偏倚风险图

图3 纳入研究的偏倚风险概况图

表2 纳入研究的偏倚风险

纳入研究	发表时间	随机序列的产生	分配隐藏	参与者盲法	评估者盲法	结局数据完整性	选择报告	其他偏倚
Beer ^[9]	1991	U	U	H	L	L	U	L
Murphy ^[14]	1993	L	U	H	L	L	U	L
Ritter ^[15]	1994	L	U	H	L	L	U	L
Ovadia ^[16]	1997	L	U	H	L	L	U	L
Kim ^[18]	1998	U	U	H	L	L	U	L
Crevoisier ^[17]	1998	L	U	H	L	L	U	L
Niskanen ^[19]	2000	U	U	H	L	L	U	L
Widman ^[20]	2002	L	U	H	L	L	U	L
Gonzalez ^[21]	2004	L	U	H	L	L	U	L
Johansson T^[23]	2005	L	U	H	L	L	U	L
Walmsley ^[22]	2005	U	U	H	L	L	U	L
Dora ^[2]	2007	U	U	H	L	L	U	L
Strahovnik ^[8]	2010	L	U	H	L	L	U	L
Cheung ^[24]	2010	L	U	H	L	L	U	L
Kleinert ^[25]	2012	L	U	H	L	L	U	L

表2 纳入研究的偏倚风险

纳入研究	发表时间	随机序列的产生	分配隐藏	参与者盲法	评估者盲法	结局数据完整性	选择报告	其他偏倚
Beer ^[9]	1991	U	U	H	L	L	U	L
Murphy ^[14]	1993	L	U	H	L	L	U	L
Ritter ^[15]	1994	L	U	H	L	L	U	L
Ovadia ^[16]	1997	L	U	H	L	L	U	L
Kim ^[18]	1998	U	U	H	L	L	U	L
Crevoisier ^[17]	1998	L	U	H	L	L	U	L
Niskanen ^[19]	2000	U	U	H	L	L	U	L
Widman ^[20]	2002	L	U	H	L	L	U	L
Gonzalez ^[21]	2004	L	U	H	L	L	U	L
Johansson T^[23]	2005	L	U	H	L	L	U	L
Walmsley ^[22]	2005	U	U	H	L	L	U	L
Dora ^[2]	2007	U	U	H	L	L	U	L
Strahovnik ^[8]	2010	L	U	H	L	L	U	L
Cheung ^[24]	2010	L	U	H	L	L	U	L
Kleinert ^[25]	2012	L	U	H	L	L	U	L

图4 引流组和不引流组术后感染率对比森林图

图5 引流组和不引流组术后感染率对比漏斗图

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摘要

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Meta-analysis of association between drainage and postoperative infection after hip replacement

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Meta-analysis of association between drainage and postoperative infection after hip replacement