Pradhan Ben B, Tatsumi Robert L, Gallina Jason, Kuhns Craig A, Wang Jeffrey C, Dawson Edgar G
Risser Orthopaedic Group, Pasadena, CA 91107, USA.
Spine (Phila Pa 1976). 2008 Sep 1;33(19):2079-82. doi: 10.1097/BRS.0b013e31818396f4.
Retrospective review.
To evaluate the effect of postoperative use of ketorolac (Toradol) on spinal fusion in humans.
The value of parenteral ketorolac in postoperative analgesia has been well documented across surgical specialties. However, some studies have shown that ketorolac may adversely affect osteogenic activity and fracture healing.
A total of 405 consecutive patients who underwent primary lumbar posterolateral intertransverse process fusion with pedicle screw instrumentation were included in this retrospective study. A subtotal of 228 patients received Toradol after surgery for adjunctive analgesia. Each patient received a mandatory dose of 30 mg intravenously every 6 hours for 48 hours. The same surgeon performed the fusion procedure on all of these patients. Historical controls included 177 patients who did not receive Toradol after surgery. The minimum follow-up period was 24 months. Nonunions were diagnosed by analyzing sequential radiographs, flexion-extension radiographs, and computed tomography with multiplanar reconstructions. The gold standard of surgical exploration was performed in symptomatic patients with diagnostic ambiguity or nonunions diagnosed by imaging.
There were no smokers in the study population. Pseudarthrosis was identified in 12 of 228 patients (5.3%) who received Toradol after surgery, and in 11 of 177 patients (6.2%) who did not. There was no significant difference detected in the nonunion rates between the two groups (P > 0.05, chi2 method).
Use of ketorolac after spinal fusion surgery in humans, limited to 48 hours after surgery for adjunctive analgesia, has no significant effect on ultimate fusion rates.
回顾性研究。
评估术后使用酮咯酸（托拉朵）对人体脊柱融合的影响。
胃肠外给予酮咯酸在术后镇痛中的价值已在各外科专业中得到充分证明。然而，一些研究表明酮咯酸可能对成骨活性和骨折愈合产生不利影响。
本回顾性研究纳入了405例连续接受初次腰椎后外侧横突间融合并椎弓根螺钉内固定术的患者。共有228例患者术后接受托拉朵辅助镇痛。每位患者每6小时静脉注射30mg的强制剂量，持续48小时。所有这些患者均由同一位外科医生进行融合手术。历史对照包括177例术后未接受托拉朵的患者。最短随访期为24个月。通过分析连续的X线片、屈伸位X线片以及多平面重建的计算机断层扫描来诊断骨不连。对于诊断不明确或经影像学诊断为骨不连的有症状患者，进行手术探查的金标准检查。
研究人群中无吸烟者。术后接受托拉朵的228例患者中有12例（5.3%）发生假关节，未接受托拉朵的177例患者中有11例（6.2%）发生假关节。两组间骨不连发生率无显著差异（P>0.05，卡方检验）。
在人体脊柱融合手术后使用酮咯酸，限于术后48小时用于辅助镇痛，对最终融合率无显著影响。
