体重指数与肩关节置换临床结果的荟萃分析△

Relationship between body mass index and clinical outcomes of shoulder arthroplasty: a meta-analysis

摘要:

［目的］ 探讨身体质量指数 （body mass index, BMI） 与肩关节置换术后临床效果的关系。［方法］ 搜索英文数据库 PubMed, Embase, Web of Science, Cochrane 与中文数据库万方、CNKI、维普中关于肥胖与肩关节置换术相关的文献。采用纽卡斯尔-渥太华量表 （Newcastle-Ottawa Scale, NOS） 对文献质量进行评价，文献数据采用 Cochrane 协作网提供的 Revman5.3 软件进行荟萃分析。［结果］ 最终纳入 10 篇文献，每项研究的样本量 76~144 139 例，所有纳入的研究均为观察性研究，包括 3 个前瞻性研究和 7 个回顾性研究，均为高质量研究。荟萃分析结果显示，肥胖患者（BMI>30 kg/m2 ）术后感染率较高 ［OR=3.83, 95%CI （2.72~5.41），I 2 =64%］，且术后静脉血栓栓塞发生率也较高 ［OR=3.93，95%CI （3.61~4.29）］。超重患者 （BMI>25 kg/ m2 ） 手术时间更长 ［MD=6.90，95%CI （3.79~10.00），I 2 =0%］。超重患者和正常体重患者在术后并发症 ［OR=0.87，95%CI （0.71~1.08），I 2 =38%］、术后翻修率 ［OR=1.48，95%CI （1.39~1.57），I 2 =71%］、住院时间 ［MD=0.03，95%CI （-0.03~0.09）， I 2 =1%］和美国肩肘外科医生（American Shoulder and Elbow Surgeons, ASES）［MD=0.36，95% CI （-7.38~8.11），I 2 =0%］评分的差异均无统计学意义。［结论］肥胖患者接受肩关节置换术治疗后感染率升高，并且超重患者手术时间更长，但综合看来，所有患者均能获得良好的功能，肩关节置换术对患者是有益的。

Abstract:

[Objective] To explore whether body mass index (BMI) is associated with adverse events after shoulder arthroplasty. [Methods] The published papers about the relationship between obesity and shoulder arthroplasty were searched from databases, such as PubMed, EMBASE, Web of Science and Cochrane in English, as well as Wanfang, CNKI and VIP in Chinese. The quality of the literatures was evaluated by Newcastle Ottawa scale (NOS) , and the data of the included literatures were extracted. Revman 5.3 software provided by Cochrane Collaboration Network was used for a meta-analysis. [Results] A total of 10 literatures were included, with sample size in each study ranged from 76 to 144139. All the studies were enrolled as observational studies, including 3 prospective studies and 7 retrospective studies, which all proved of high-quality. As results of the meta-analysis, the obesity (BMI＞30 kg/m2 ) had significantly higher postoperative infection rate [OR=3.83, 95% CI (2.72~5.41) , I 2 =64% ] , significantly higher incidence of venous thrombosis [OR=3.93, 95% CI (3.61~ 4.29) ] , while the overweight (BMI＞25kg/m2 ) consumed significantly longer operation time [MD=6.90, 95%CI (3.79~10.00) , I 2 =0%] . How- ever, there were no significant differences between the overweight patients and the normal weight patients in terms of postoperative compli- cations [OR=0.87, 95%CI (0.71~1.08) , I 2 =38%] , postoperative revision rates [OR=1.48, 95%CI (1.39~1.57) , I2 =71%] , hospitalization time [MD=0.03, 95%CI (-0.03~0.09) , I 2 =1%] and American Shoulder and Elbow Surgeon (ASE) scores [MD=0.36, 95%CI (-7.38~8.11) , I 2 =0%] . [Conclusion] The obesity has considerably higher risk of infection and takes significantly longer operation time, However, all pa- tients do get benefit from shoulder arthroplasty.