非甾体类抗炎药对肌腱-骨愈合的影响：一项亚组荟萃分析的系统评价
The Effect of Non-Steroidal Anti-Inflammatory Drugs on Tendon-to-Bone Healing: A Systematic Review with Subgroup Meta-Analysis.
作者信息
Duchman Kyle R, Lemmex Devin B, Patel Sunny H, Ledbetter Leila, Garrigues Grant E, Riboh Jonathan C
机构信息
University of Iowa Hospitals and Clinics, Department of Orthopedics & Rehabilitation, Iowa City IA USA.
Duke University Medical Center, Department of Orthopaedic Surgery, Durham NC USA.
出版信息
Iowa Orthop J. 2019;39(1):107-119.
BACKGROUND
There is some concern that non-steroidal anti-inflammatory drugs (NSAIDs) may impair the healing of certain musculoskeletal tissues. However, the effect of NSAIDs on the specialized fibrocartilaginous transition at the tendon-to-bone interface remains largely unknown. Thus, the purpose of the present study is to investigate the effect of NSAIDs on tendon-to-bone healing following acute injury or surgery.
METHODS
A systematic review was performed according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PubMed (MEDLINE), Embase, Cumulative Index to Nursing and Allied Health (CINAHL), and SportDiscus databases were searched from the time of database inception to May 14, 2018 to identify all clinical and basic science studies investigating the effect of NSAIDs on tendon-to-bone healing. Methodological quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) and SYstematic Review Center for Laboratory animal Research (SYRCLE) risk of bias assessment tools for clinical and basic science studies, respectively. A qualitative synthesis of the literature was performed with a subgroup meta-analysis of homogeneous basic science studies.
RESULTS
A total of 13 studies, including three clinical and 10 basic science studies, were included. The overall methodological quality of the included clinical studies was poor, while assessment of the basic science studies revealed consistent areas at high or unclear risk of bias. Of the included clinical studies, a single study reported a higher rate of rotator cuff repair failure with selective (COX-2) NSAID use compared with non-selective NSAID use, while no clinical failures were noted with NSAID use following distal biceps tendon repair. Basic science studies had heterogeneous outcome reporting. A subgroup analysis of homogeneous animal studies revealed no significant effect of all NSAIDs (Standard Mean Difference [SMD] -1.05, 95% Confidence Interval [CI] -2.39-0.30, p=0.13) or non-selective NSAIDs on load to failure (SMD -0.62, 95% CI -1.26-0.02, p=0.06).
CONCLUSIONS
The current literature does not provide sufficient evidence for or against the use of NSAIDs following acute injury or surgical repair of the tendon-bone interface. IV.
背景
有人担心非甾体抗炎药（NSAIDs）可能会损害某些肌肉骨骼组织的愈合。然而，NSAIDs对肌腱-骨界面处特殊纤维软骨过渡的影响仍 largely未知。因此，本研究的目的是调查NSAIDs对急性损伤或手术后肌腱-骨愈合的影响。
方法
根据2009年系统评价和Meta分析的首选报告项目（PRISMA）指南进行系统评价。从数据库建立到2018年5月14日，检索了PubMed（MEDLINE）、Embase、护理及相关健康累积索引（CINAHL）和SportDiscus数据库，以识别所有调查NSAIDs对肌腱-骨愈合影响的临床和基础科学研究。分别使用非随机研究方法学指数（MINORS）和实验室动物研究系统评价中心（SYRCLE）偏倚风险评估工具对临床和基础科学研究的方法学质量进行评估。对文献进行定性综合，并对同类基础科学研究进行亚组Meta分析。
结果
共纳入13项研究，包括3项临床研究和10项基础科学研究。纳入的临床研究总体方法学质量较差，而对基础科学研究的评估显示存在偏倚风险较高或不明确的一致领域。在纳入的临床研究中，一项研究报告与使用非选择性NSAIDs相比，选择性（COX-2）NSAIDs使用者肩袖修复失败率更高，而肱二头肌远端肌腱修复后使用NSAIDs未发现临床失败情况。基础科学研究的结果报告存在异质性。同类动物研究的亚组分析显示，所有NSAIDs（标准均数差[SMD]-1.05，95%置信区间[CI]-2.39-0.30，p=0.13）或非选择性NSAIDs对失效负荷均无显著影响（SMD-0.62，95%CI-1.26-0.02，p=0.06）。
结论
目前的文献没有提供足够的证据支持或反对在肌腱-骨界面急性损伤或手术修复后使用NSAIDs。四、
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