急性脊髓损伤外科干预时机对神经功能恢复影响的系统评价

Effect of surgical intervention time on the recovery of nerve function in acute spinal cord injury:a Meta analysis

目的 :系统评价不同手术时机对急性脊髓损伤患者神经功能恢复的影响。方法 :计算机检索Pub Med、EMBASE、Cochrane Library、ISI Web of knowledge、中国生物医学文献数据库、中文科技期刊全文数据库(VIP)、中国期刊全文数据库(CNKI)及万方数据库中不同手术时机干预治疗急性脊髓损伤的随机对照试验(RCT),检索时间均从建库至2017年2月。结果:纳入4个RCT,共156例急性脊髓损伤的患者。在不完全性脊髓损伤患者当中早期手术可以改善患者ASIA运动功能评分[MD=3.29,95%CI(-7.90,14.49),P=0.56],Frankel评分总体改善率[OR=7.65,95%CI(2.69,21.74),P=0.000 1];在完全性脊髓损伤患者当中早期手术与晚期手术对患者Frankel评分总体改善率影响不明显[OR=4.88,95%CI(0.74,32.09),P=0.10];早期手术与晚期手术对住院时间[MD=-3.4,95%CI(-8.12,1.32),P=0.16],死亡率[OR=1.07,95%CI(0.21,5.56),P=0.93],褥疮发生率[OR=1.07,95%CI(0.17,6.69),P=0.94]差异无统计学意义。结论 :早期手术在一定程度上能促进患者脊髓功能恢复,也并没有带来更多的并发症,未来仍需要进行高质量的随机对照研究来验证这个结论。

Objective：To evaluate the efficacy and safety of different operation time for acute spinal cord injury（SCI）based on systematic review. Methods：Pub Med database,EMBASE database,Cochrane Library,ISI Web of knowledge,CBM database,VIP database,CNKI database and Wanfang database were searched from their start year up to February 2017 for relevant randomized clinical trials on the treatment of acute spinal cord injury with different intervention times. Results：Four randomized clinical trials of total 156 cases were included. Early surgical intervention for the patients with incomplete spinal cord injury can improve the ASIA motor function score [MD=3.29,95%CI（-7.90,14.49）,P=0.56] and overall Frankel score [OR=7.65,95% CI（2.69,21.74）,P =0.000 1]. There was no significant difference in the improvement of the overall Frankel score[OR=4.88,95%CI（0.74,32.09）,P=0.10] for the patients with complete spinal cord injury between the early surgery and delayed surgery group. There was no significant difference in hospitalization time [MD=-3.4,95%CI（-8.12,1.32）,P=0.16],death rate [OR =1.07,95% CI（0.21,5.56）,P =0.93]and incidence of decubitus [OR =1.07,95% CI（0.17,6.69）,P =0.94] between the early surgery and delayed surgery group. Conclusion：Early surgical intervention can promote the nerve function recovery after spinal cord injury,whithout further incidence of complications,but random control trails with higher quality are still required for this conclusion.