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对于青少年特发性脊柱侧弯行后路脊柱融合及内固定术后,使用酮咯酸并不会增加假关节形成的风险。

Postoperative ketorolac does not predispose to pseudoarthrosis following posterior spinal fusion and instrumentation for adolescent idiopathic scoliosis.

作者信息

Sucato Daniel J, Lovejoy John F, Agrawal Sundeep, Elerson Emily, Nelson Trudi, McClung Anna

机构信息

TX Scottish Rite Hospital, Department of Orthopaedic Surgery, University of Texas at Southwestern Medical Center, 2222 Welborn Street, Dallas, TX 75219, USA.

出版信息

Spine (Phila Pa 1976). 2008 May 1;33(10):1119-24. doi: 10.1097/BRS.0b013e31816f6a2a.

Abstract

STUDY DESIGN

A retrospective review comparing patients who had postoperative ketorolac and those who did not following posterior spinal fusion and instrumentation (PSFI) for adolescent idiopathic scoliosis (AIS).

OBJECTIVE

To analyze the effect of postoperative ketorolac on the incidence of pseudoarthrosis in postoperative AIS patients.

SUMMARY OF BACKGROUND DATA

Ketorolac (Toradol, Roche Laboratories, Nutley, NJ) is a nonsteroidal antiinflammatory drug that is an effective adjunct to manage postoperative pain. It has been previously demonstrated to inhibit spinal fusion in adult patients undergoing a L4 to sacral fusion. To our knowledge, there are no large studies analyzing this effect following PSFI for AIS.

METHODS

An IRB-approved retrospective medical record review was performed from 1994 to 2000 of patients undergoing a PSFI for AIS at a single institution. Segmental spinal instrumentation (Texas Scottish Rite Hospital) and iliac crest bone graft were used in both groups. Demographic and operative data were recorded. Patients were divided into those who had postoperative ketorolac (K group) and those who did not (NK group). Patients who had a surgically confirmed pseudoarthrosis were identified and the K group and NK group were statistically compared.

RESULTS

There were 161 patients in the NK group and 158 in the K group. There were no differences with respect to age (14.4 vs. 14.2 years), gender (83.9% vs. 84.8% females), levels fused (9.8 vs. 9.7), or preoperative curve magnitude (57.9 degrees vs. 58.9 degrees ). In the K group, the number of doses of ketorolac administered was 6.7 for an average of 26.7 mg for a duration of 46 hours after surgery. Patients in the K group were more likely to have Motrin (average 5.8 doses) compared with the NK group (average 0.7 doses) (P < 0.01). No patient in the K group had a history of cigarette smoking compared with 2 patients in the NK group, both of whom went on to solid arthrodesis. The overall incidence of pseudoarthrosis was 2.5% for all patients. There was no difference in the incidence of pseudoarthrosis comparing the K (1.9%) and the NK group (3.1%)(P = 0.7). When the single rod posterior implants were excluded, there was no difference between the K (0.7%) and NK groups (1.8%) (P = 0.58).

CONCLUSION

Ketorolac does not increase the incidence of developing a pseudoarthrosis when used as an adjunct for postoperative analgesia following a PSFI for AIS using segmental spinal instrumentation and iliac crest bone graft. The differences seen here compared with adults may be due to the greater healing potential in these young patients. We recommend utilization of ketorolac after surgery to supplement pain management when necessary.

摘要

研究设计

一项回顾性研究,比较青少年特发性脊柱侧凸(AIS)后路脊柱融合内固定术(PSFI)后使用酮咯酸与未使用酮咯酸的患者。

目的

分析术后使用酮咯酸对AIS术后患者假关节形成发生率的影响。

背景数据总结

酮咯酸(托拉朵,罗氏实验室,新泽西州纳特利)是一种非甾体抗炎药,是术后疼痛管理的有效辅助药物。此前已证明其会抑制接受L4至骶骨融合术的成年患者的脊柱融合。据我们所知,尚无大型研究分析PSFI治疗AIS后这种影响。

方法

对1994年至2000年在单一机构接受AIS的PSFI治疗的患者进行了一项经机构审查委员会批准的回顾性病历审查。两组均使用节段性脊柱内固定(德克萨斯州苏格兰 rite医院)和髂嵴骨移植。记录人口统计学和手术数据。患者分为术后使用酮咯酸的患者(K组)和未使用酮咯酸的患者(NK组)。确定手术确诊为假关节的患者,并对K组和NK组进行统计学比较。

结果

NK组有161例患者,K组有158例患者。在年龄(14.4岁对14.2岁)、性别(女性83.9%对84.8%)、融合节段数(9.8对9.7)或术前侧弯角度(57.9度对58.9度)方面无差异。在K组中,术后给予酮咯酸的剂量为6.7剂,平均26.7毫克,术后持续46小时。与NK组(平均0.7剂)相比,K组患者更可能使用布洛芬(平均5.8剂)(P<0.01)。K组没有患者有吸烟史,而NK组有2例患者有吸烟史,这2例患者均实现了坚固的融合。所有患者的假关节总发生率为2.5%。比较K组(1.9%)和NK组(3.1%)的假关节发生率无差异(P = 0.7)。排除单棒后路植入物后,K组(0.7%)和NK组(1.8%)之间无差异(P = 0.58)。

结论

在使用节段性脊柱内固定和髂嵴骨移植进行AIS的PSFI术后,酮咯酸作为术后镇痛辅助药物使用时,不会增加假关节形成的发生率。与成年人相比这里观察到的差异可能是由于这些年轻患者具有更大的愈合潜力。我们建议术后必要时使用酮咯酸补充疼痛管理。

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