Meta-analysis Of The Efficacy And Safety Of Chinese Medicine Intervention In Perio Perative Swelling And Pain Of Ankle Fracture

Objective:Evidence-based meta-analysis method was used to collect relevant literature and systematically evaluate the efficacy and safety of traditional Chinese medicine intervention in perioperative swelling and pain of ankle fracture,providing clinical evidence-based basis for the interventional treatment of traditional Chinese medicine in perioperative swelling and pain after ankle fracture.Methods: According to the established search terms and methods,China National Knowledge Network(CNKI),VIP,Wan Fang Data,China Biomedical Database(CBM),Pub Med,EMbase,The Cochrane Library and other databases searched randomized controlled trials(RCTS)of clinical intervention of perioperative swelling pain of ankle fracture with traditional Chinese medicine from the establishment of the database to the publication on November 30,2022.Two researchers use Note Ex Press3.5 software to independently screen the literature according to relevant inclusion and arrangement standards.If opinions differ,the third researcher will determine whether to include the literature.Using the modified JADAD scale and Rev Man 5.4 The software evaluated the quality of the included literatures and extracted data such as outcome indicators(1)total effective rate(2)swelling value(3)VAS score(4)preoperative waiting time(5)time of first cutaneous sign(6)complications(incidence of DVT,delayed or non-union incision,incision infection,tension blister)(7)safety indicators--incidence of adverse drug reactions,Finally,meta-analysis was performed on the collated data combined with clinical cognition.Result: A total of 23 RCTS were included,including a total of 1347 patients,including 675 patients in the experimental group and 672 patients in the control group.Results of meta-analysis(1)Total effective rate: There were 13 reports,and the results after excluding the heterogeneous literatures [RR=1.21,95%CI(1.14,1.29),Z=5.90,P < 0.00001] showed that the curative effect of TCM intervention treatment group was better than that of conventional western medicine treatment group.In terms of subgroups,RR(preoperative)=1.21=RR(postoperative)=1.21,and the effect of TCM intervention on detumescence was similar at different stages before and after surgery.(2)Swelling value: [MD=-0.44,95%CI(-0.52,-0.36),Z=10.86,P < 0.00001],MD(preoperative)=-0.39 > MD(postoperative)=-0.52.The swelling value of TCM intervention treatment group was lower than that of conventional Western medicine treatment group,and the improvement effect of postoperative use of TCM was better than that of preoperative.(3)Pain VAS score: [MD=-0.71,95%CI(-0.86,-0.56),Z=9.10,P < 0.00001],MD(preoperative)=-0.75 < MD(postoperative)=-0.67,the VAS score of TCM intervention treatment group was lower than that of conventional Western medicine treatment group,and the preoperative pain relief effect was better than that of postoperative.(4)Preoperative waiting time: [MD=-2.39,95%CI(-3.76,-1.03),Z=3.44,P < 0.00001],the operation waiting time of TCM intervention treatment group was shorter than that of Western treatment group.(5)The occurrence time of the first dermal sign: there were three reports,and the results were as follows [MD=-3.41,95%CI(-3.97,-2.85),Z=11.98,P <0.00001] after removing the heterogeneous literatures.The first dermal sign appeared earlier in the TCM intervention group than in the Western treatment group,and the rate of detumation was faster.(6)Complications: The incidence of tension blisters in the TCM intervention group [RR=0.27,95%CI(0.11,0.70),Z=2.70,P=0.007] was lower than that in the conventional western treatment group,and the incidence of DVT [RR=0.18,95%CI(0.03,0.98),Z=1.99,P=0.05],incidence of delayed or nonunion incision [RR=0.20,95%CI(0.04,1.13),Z=1.83,P=0.07],incidence of incision infection[RR=0.22,95%CI(0.04,1.29),Z=1.68,P=0.09] was similar to the conventional treatment group of western medicine,and the difference was not statistically significant.(7)Safety index-adverse reactions: TCM intervention therapy and conventional Western medicine treatment both have higher safety,adverse reactions are less.Conclusion:(1)On the basis of conventional Western medicine treatment,the clinical effect of Chinese medicine in the intervention of perioperative swelling pain of ankle fracture is more significant than that of conventional Western medicine treatment in terms of total effective rate,swelling value,VAS score,preoperative waiting time,time for the first dermal sign occurrence and prevention of tension blister.The effects of DVT prevention,delayed incision healing or non-healing,incision infection and other aspects are similar to those of conventional Western medicine.(2)In terms of drug safety,the safety level of TCM intervention treatment group was roughly the same as that of conventional Western medicine treatment group,indicating that both TCM and Western medicine treatments have high safety and less adverse reactions,which can be used safely in clinic.(3)Most of the literatures included in this study are of low quality and the sample size is small.The above conclusions have certain limitations,and more high-quality,multi-center,and large sample size randomized controlled trials are needed to update the results.