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坐骨神经痛非手术治疗患者预后预测因素的系统评价。

Systematic review of prognostic factors predicting outcome in non-surgically treated patients with sciatica.

机构信息

Department of General Practice, Erasmus MC University Medical Center Rotterdam, The Netherlands.

出版信息

Eur J Pain. 2013 Sep;17(8):1126-37. doi: 10.1002/j.1532-2149.2013.00301.x. Epub 2013 Mar 14.

Abstract

Identification of prognostic factors for surgery in patients with sciatica is important to be able to predict surgery in an early stage. Identification of prognostic factors predicting persistent pain, disability and recovery are important for better understanding of the clinical course, to inform patient and physician and support decision making. Consequently, we aimed to systematically review prognostic factors predicting outcome in non-surgically treated patients with sciatica. A search of Medline, Embase, Web of Science and Cinahl, up to March 2012 was performed for prospective cohort studies on prognostic factors for non-surgically treated sciatica. Two reviewers independently selected studies for inclusion and assessed the risk of bias. Outcomes were pain, disability, recovery and surgery. A best evidence synthesis was carried out in order to assess and summarize the data. The initial search yielded 4392 articles of which 23 articles reporting on 14 original cohorts met the inclusion criteria. High clinical, methodological and statistical heterogeneity among studies was found. Reported evidence regarding prognostic factors predicting the outcome in sciatica is limited. The majority of factors that have been evaluated, e.g., age, body mass index, smoking and sensory disturbance, showed no association with outcome. The only positive association with strong evidence was found for leg pain intensity at baseline as prognostic factor for subsequent surgery.

摘要

确定坐骨神经痛患者手术的预后因素对于能够在早期预测手术非常重要。确定预测持续性疼痛、残疾和恢复的预后因素对于更好地了解临床病程、告知患者和医生以及支持决策制定非常重要。因此,我们旨在系统地综述非手术治疗的坐骨神经痛患者的预后因素。对截止到 2012 年 3 月的 Medline、Embase、Web of Science 和 Cinahl 进行了前瞻性队列研究的预后因素的搜索。两位评审员独立选择纳入的研究,并评估偏倚风险。结局为疼痛、残疾、恢复和手术。为了评估和总结数据,进行了最佳证据综合。最初的搜索产生了 4392 篇文章,其中有 23 篇文章报道了 14 个原始队列,符合纳入标准。研究之间存在较高的临床、方法学和统计学异质性。关于坐骨神经痛结局预测的预后因素的报告证据有限。已经评估的大多数因素,例如年龄、体重指数、吸烟和感觉障碍,与结局没有关联。唯一具有强证据的阳性关联是基线时的腿部疼痛强度作为随后手术的预后因素。

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