糖尿病与脊柱手术并发症：对比或控制性研究的Mela分析

Diabetes and complications of spinal surgery: a meta-analysis of comparative or controlled studies

背景:目前椎间盘切除、融合或减压被认为是一种有效的常规修复脊柱疾病的方法。虽然已经有大量文献报道糖尿病对脊柱手术带来不良影响,但是仍存在一定的分歧。目的:对有关糖尿病对脊柱手术并发症影响的观察性研究及病例对照性研究进行系统性评价。方法:根据纳入标准,搜索数据库选择糖尿病对脊柱手术结果及并发症影响的对控制或对比性研究,观察指标包括死亡率、翻修率、手术部位感染、静脉血栓发生率、失血量、手术时间及住院时间。2名作者分别进行文章数据的提取及纳入研究的方法学和质量评估。根据流行病学观察研究(MOOSE)的指导方针来进行Meta分析,使用RevMan 5.2软件进行提取数据的风险评估。结果与结论:共纳入18篇文献,包含有2 824 063例患者,结果显示,糖尿病患者行脊柱手术后死亡率、手术部位感染、静脉血栓发生率均较非糖尿病患者高,住院时间较非糖尿病患者长,差异有显著性意义(P<0.05);而翻修的风险、术中失血量及手术时间三者差异无显著性意义(P>0.05)。提示糖尿病患者接受脊柱手术比非糖尿病患者有更高的风险,糖尿病增加了脊柱手术后死亡率、手术部位感染、静脉血栓的风险及住院时间。

BACKGROUND： Currently, discectomy, fusion or decompression is considered an effective and conventional method for the treatment of spinal disease. Although there have been many reports on the adverse effects of diabetes on spinal surgery, but there are still some differences. OBJECTIVE： To systematically evaluate the observational studies and case-control studies about the effect of diabetes on the complications of spinal surgery. METHODS： The controlled and comparative studies regarding the effect of diabetes on the results and complications of spinal surgery were searched from the database according to the inclusion criteria. The observed indicators including mortality, revision rate, surgical site infection, the incidence of venous thrombosis, blood loss, operative time and hospitalization time. Two authors participated in extracting the data and evaluating the methodology and quality of the included studies. Meta-analysis was conducted according to the guidelines of epidemiological observational studies （MOOSE）. The risk assessment of the extracted data was conducted using i, RevMan 5.2 software. RESULTS AND CONCLUSION： Eighteen literatures, involving 2 824 063 patients, were eventually enrolled. Theexperimental result showed that the mortality, surgical site infection, incidence of venous thrombosis of diabetic patients after the spinal surgery were significantly higher than those of non-diabetic patients; the hospital stay was significantly longer than that of non-diabetic patients （P 〈 0.05）. There were no significant differences in the risk of revision, intraoperative blood loss and operation time between diabetic patients and non-diabetic patients （P 〉 0.05）. These results suggest that diabetic patients take a higher risk once accepting the spinal surgery than the non-diabetic patients. Diabetes increases the risks of postoperative mortality, surgical site infection, venous thrombosis and hospitalization time after spinal surgery.