| BackgroundAcetabular fractures (AF) are intracranial fractures caused by multiple kinds of forces. The main treatment is usually treated with Open Reduction And Internal Fixation (ORIF), but Heterotopic Ossification (HO) is an common complication to patients with acetabular fractures. A large number of ectopic osteogenesis around the acetabulum will lead to severe limitation of the range of hip movement. Limb loss of function while increasing the chance of bedsores and limb pain long-term outcome.Indomethacin as one kind of non-steroidal anti-inflammatory analgesic drugs, mainly used for relieve pain, studies have shown that it helps to prevent osteogenesis after acetabular fractures surgical treatment. However, the result for oral indomethacin for the prevention of acetabular fractures after the treatment of heterotopic ossification is still controversial.In this study, the clinical efficacy of indomethacin was carried out to discuss its clinical efficacy in the prevention of heterotopic ossification and severe heterotopic ossification by meta-analysis.ObjectivesUsing Meta-analysis and systematic evaluate the clinical efficacy of the indomethacin in the treatment of acetabular fractures after operation which have been reported, and to explore its clinical efficacy in the prevention of heterotopic ossification and severe heterotopic ossification. To provide more evidence-based medical evidence for the choice of clinical treatment options and clinical decision-making.MethodsRetrieval method: Using computer and the manual way to search the National Library of Medicine National Biotechnology Information Center (Pubmed), the United States Cochrance library (Cochrance library), the Netherlands Elsevier Science bookstore database (EMBase),clinical decision-making evidence database Foreign Evidence-Based Medicine FEBM), Thomson Reuters Corporate Information Retrieval Platform (Web of Science), American Clinical Trials Database (Clinical Trial) . China National Science Library (CBMdisc), China National Knowledge Infrastructure (CNKI), China National Periodical Database (CSPD), Vipu full-text database and other databases,Widely collect the papers about treatment of heterotopic ossification after the acetabular fracture surgical treatment. Search deadline February 2017.In this study,randomized controlled trial (Randomized Controlled Trail,RCT)'and semi-randomized controlled trials were collected by making a series of inclusion and exclusion criteria to compare the clinical efficacy of use indomethacin in those research.Data extraction and analysis: the two groups carry out the literature search evaluation included in the iterature data collection and retrieval separately. The Review Manager(RevMan) 5.3, R software and test sequence analysis software (Trial Sequential (TSA)were used to analyze the heterogeneity of heterotopic ossification and severe heterotopic ossification in the literature.Result5 articles were included in the study: 4 prospective study literature, 1 retrospective study literature; 4 English literature, 1 Chinese literature. A total of 480 patients with acetabular fractures.The literature was scored by using the Jadad rating scale, two of which were high quality literature and three low quality literatures. Meta-analysis was performed on the extracted data, and the results showed that indomethacin was used in the treatment of acetabular fractures after reduction and internal fixation in patients with heterotopic ossification compared with placebo. There was no significant heterogeneity between the two groups (Chi2=3.13, p=0.54:12=0%) due to I2 <50%.The effect of each group was combined with the fixed effect model. OR = 0.59, 95%confidence interval (CI) was 0.39 ? 0.90 (Z = 2.45 P = 0.01 <0.05) was statistically significant (P <0.05).the results showed that indomethacin was used in the treatment of acetabular fractures after reduction and internal fixation in patients with severe heterotopic ossification compared with placebo. There was no significant heterogeneity between the two groups (Chi2 = 7.91, p = 0.09: I2 = 49%) due to I2<50%. The effect of each group was combined with the fixed effect model. RR = 0.67,95% confidence interval (CI) was 0.24 ?1.84 (Z = 0.78 P = 0.44). was no statistically significant(P> 0.05). Prevention of acetabular fractures after resection and internal fixation in patients with heterotopic ossification compared with the use of placebo group treatment will lead to more side effects, mainly for gastrointestinal side effects,(Chi2 = 0.27, p = 0.87:12 = 0%), I2 <50%, so the data between groups can be regarded as homogeneous, the effect of each group combined with a fixed effect model, OR =0.59, 95% confidence interval (CI) 1.99 ?59.25 (Z = 2.75 P = 0.006 <0.05) There was significant statistical differences.ConclusionApplication of indomethacin in the treatment of acetabular fractures in patients with internal fixation is more effective in preventing heterotopic ossification than in placebo group.Application of indomethacin in the treatment of acetabular fractures with open reduction and internal fixation in patients with severe heterotopic ossification compared with the placebo group, no preventive effect.Application of indomethacin compared to placebo group can lead to the occurrence of gastrointestinal side effects... |
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