前路腰椎体间融合术伴或不伴“手术辅助医生”：一项系统评价和荟萃分析。
Anterior Lumbar Interbody Fusion With and Without an "Access Surgeon": A Systematic Review and Meta-analysis.
机构信息
NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia.
University of New South Wales (UNSW), Sydney, New South Wales, Australia.
出版信息
Spine (Phila Pa 1976). 2017 May 15;42(10):E592-E601. doi: 10.1097/BRS.0000000000001905.
STUDY DESIGN
A systematic review and meta-analysis.
OBJECTIVE
The aim of this study was to investigate the outcomes of anterior lumber interbody fusion (ALIF) with and without an "access surgeon."
SUMMARY OF BACKGROUND DATA
Anterior approaches for spine operations have become increasingly popular but may often involve unfamiliar anatomy and territory for spine surgeons, potentially placing the patient at risk to a greater proportion of approach-related complications. Thus, many spine surgeons require or prefer the assistance of an "access surgeon" to perform the exposure. However, there has been much debate about the necessity of an "access surgeon."
METHODS
A systematic search of six databases from inception to April 2016 was performed by two independent reviewers. Meta-analysis was used to pool overall rates, and compare the outcomes of ALIF with an access surgeon and without.
RESULTS
A total of 58 (8028 patients) studies were included in this meta-analysis. The overall intraoperative complications were similar with and without an "access surgeon." The overall pooled rate of arterial injuries [no access 0.44% vs. access 1.16%, odds ratio (OR) 2.67, P < 0.001], retrograde ejaculation (0.41% vs. 0.96%, OR 2.34, P = 0.005), and ileus (1.93% vs. 2.26%, OR 2.45, P < 0.001) was higher with an "access surgeon." However, the overall pooled rates of peritoneal injury (0.44% vs. 0.16%, OR 0.36, P = 0.034) and neurological injury (0.99% vs. 0.11%, OR 0.11, P < 0.001) were lower with an "access surgeon." Total postoperative complications (5.95% vs. 4.08%, OR 0.67, P < 0.001) were lower with an "access surgeon" along with prosthesis complications (1.59% vs. 0.89%, OR 0.56, P < 0.001) and reoperation rates (2.28% vs. 1.31%, OR 0.57, P < 0.001).
CONCLUSION
Compared with no access surgeon, the use of an access surgeon was associated with similar intraoperative complication rates, higher arterial injuries, retrograde ejaculation, ileus, and lower prosthesis complications, reoperation rates, and postoperative complications. In cases wherein exposure may be difficult, support from an "access surgeon" should be available.
LEVEL OF EVIDENCE
研究设计
系统评价和荟萃分析。
目的
本研究旨在探讨前路腰椎体间融合术（ALIF）中有无“入路助手”的结果。
背景资料概要
前路脊柱手术越来越受欢迎，但可能经常涉及脊柱外科医生不熟悉的解剖结构和区域，使患者面临更大比例的手术相关并发症风险。因此，许多脊柱外科医生需要或喜欢“入路助手”来进行暴露。然而，关于是否需要“入路助手”存在很多争议。
方法
两位独立的评审员对从成立到 2016 年 4 月的六个数据库进行了系统搜索。使用荟萃分析来汇总总体发生率，并比较有和没有入路助手的 ALIF 的结果。
结果
共有 58 项（8028 例患者）研究纳入荟萃分析。有和没有“入路助手”的术中并发症总体相似。动脉损伤的总体汇总发生率[无入路 0.44%比有入路 1.16%，比值比（OR）2.67，P<0.001]、逆行性射精（0.41%比 0.96%，OR 2.34，P=0.005）和肠梗阻（1.93%比 2.26%，OR 2.45，P<0.001）更高。然而，腹膜损伤的总体汇总发生率[无入路 0.44%比有入路 0.16%，OR 0.36，P=0.034]和神经损伤的总体汇总发生率[无入路 0.99%比有入路 0.11%，OR 0.11，P<0.001]较低。有“入路助手”的总术后并发症（5.95%比 4.08%，OR 0.67，P<0.001）和假体并发症（1.59%比 0.89%，OR 0.56，P<0.001）和再手术率（2.28%比 1.31%，OR 0.57，P<0.001）较低。
结论
与无入路助手相比，使用入路助手的术中并发症发生率相似，动脉损伤、逆行性射精、肠梗阻发生率较高，假体并发症、再手术率和术后并发症发生率较低。在暴露可能困难的情况下，应提供“入路助手”的支持。
证据水平
1 级。
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