| Objective:1.To systematically evaluate the efficacy and safety of intra-articular injection of ketorolac tromethamine and hyaluronic acid in the treatment of knee osteoarthritis by Meta-analysis,so as to provide ideas for clinical treatment of knee osteoarthritis;2.To explore the safety of ketorolac tromethamine in the treatment of early and middle stage knee osteoarthritis.Methods:1.According to the evidence-based medicine equation PICOS,determine the direction and center of literature retrieval,determine the inclusion and exclusion criteria according to the research content,and search the comprehensive and accurate relevant literatures through a comprehensive search of the literature database.2.Systematic search of major databases,Chinese databases including CNKI,Wanfang,VIP,Chinese biomedical literature,English databases including Pub Meb,Cochrane,Embase,Scopus,Web of Science,etc.,search of ketorolac tromethamine combined with hyaluronic acid in the treatment of knee osteoarthritis efficacy and safety randomized controlled trials before December 16,2022,compared with hyaluronic acid.The searched literatures were initially screened,then the literatures failing to meet the requirements were screened according to the inclusion and exclusion criteria,and the quality of the finally included literatures was assessed from seven aspects using the Cochrane systematic review bias risk evaluation tool.Meta-analysis of the collected data was also performed using Rev Man 5.4.1 software.3.Meta-analysis of the final collected data was performed using Rev Man Manager 5.4.1 software provided by the Cochrane Collaboration.Heterogeneity analysis was performed using the Q test and I2 test.When(P>0.1,I~2<50%),it indicates that there is no heterogeneity among the studies,and the fixed-effect model should be selected for meta-analysis;when(P<0.1,I~2≥50%),it indicates that there is heterogeneity among the studies,and the causes of heterogeneity should be analyzed,and the random-effect model should be selected for meta-analysis.P<0.05 was considered statistically significant.Odds ratio(OR)comparisons were used for dichotomous data.Results:1.1085 relevant literatures were searched by comprehensive search of database.Through preliminary screening,500 duplicates were excluded,571 articles were excluded after reading the abstracts,14 studies were screened for full-text reading,and finally 8 studies with a total of 687 cases were included.Seven articles reported VAS scores,two articles reported WOMAC function scores,two articles reported measurement of Lysholm knee scores,and four articles reported overall response rates;2.Meta analysis results showed that there was no significant difference in VAS,WOMAC,and Lysholm scores between ketorolac tromethamine combined with hyaluronic acid treatment and before hyaluronic acid treatment.For the treatment of knee osteoarthritis,the VAS score of ketorolac tromethamine combined with hyaluronic acid(MD=-1.35,95%CI=-2.32-0.38,P=0.006,I2=96%)is superior to hyaluronic acid;The WOMAC score(MD=-3.11,95%CI=-5.00～-1.22,Z=3.23,P=0.001)is superior to hyaluronic acid;The Lysholm knee joint score(MD=-2.81,95%CI=-3.36 to-2.00,P<0.0001,I2=86%)is superior to hyaluronic acid;The total effective rate(OR=4.22,95%CI=1.76～10.14,Z=3.22,P=0.001)was higher than that of hyaluronic acid,and the differences were statistically significant.Two articles reported adverse reactions,all of which resolved after treatment.Conclusion:1.Intra-articular injection of ketorolac tromethamine and hyaluronic acid is superior to hyaluronic acid in relieving pain and improving function in the treatment of knee osteoarthritis;2.Intra-articular injection of ketorolac tromethamine and hyaluronic acid has less adverse reactions and higher safety in the treatment of early knee osteoarthritis;3.Intra-articular injection of ketorolac tromethamine and hyaluronic acid has advantages over hyaluronic acid in the treatment of knee osteoarthritis and is worthy of clinical promotion. |
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