Li Jesse, Ajiboye Remi M, Orden Michael H, Sharma Akshay, Drysch Austin, Pourtaheri Sina
Department of Orthopaedic Surgery, UCLA Medical Center, Los Angeles.
Department of Orthopaedic Surgery, Harbor-UCLA Medical Center, Torrance, CA.
Clin Spine Surg. 2018 Mar;31(2):65-72. doi: 10.1097/BSD.0000000000000613.
Systematic review and meta-analysis.
The purpose of this study was to evaluate the effect of postoperative ketorolac administration (ie, dosage and duration of use) on pseudarthrosis following thoracolumbar posterolateral spinal fusions.
Ketorolac is a nonsteroidal anti-inflammatory drug often administered for pain control after spine surgery. The main concern with ketorolac is the risk of pseudarthrosis following fusion.
A systematic search of multiple medical reference databases was conducted for studies detailing postoperative ketorolac use in lumbar fusion and scoliosis surgery in adult and pediatric patients, respectively. Meta-analysis was performed using the random-effects model for heterogeneity as this study analyzes heterogenous patient populations undergoing variable approaches to fusion and variable numbers of levels with variable means of detection of pseudarthrosis. Outcome measure was pseudarthrosis.
Overall, 6 studies totaling 1558 patients were reviewed. Pseudarthrosis was observed in 119 (7.6%) patients. Pseudarthrosis were observed in adults with ketorolac administered for >2 days [odds ratio (OR), 3.44, 95% confidence interval (95% CI), 1.87-6.36; P<0.001], adults with doses of ≥120 mg/d (OR, 2.93, 95% CI, 1.06-8.12; P=0.039), and adults with ketorolac administered for >2 days and at doses ≥120 mg/d (OR, 4.75, 95% CI, 2.34-9.62; P<0.001). Ketorolac use in smokers was associated with pseudarthrosis (OR, 8.71, 95% CI, 2.23-34.0; P=0.002).
Ketorolac, when administered for >2 days and/or at a dose of ≥120 mg/d, is associated with pseudarthrosis in adults after posterolateral lumbar fusion. Ketorolac use in smokers is also associated with pseudarthrosis.
系统评价与荟萃分析。
本研究旨在评估术后使用酮咯酸（即剂量和使用持续时间）对胸腰椎后外侧脊柱融合术后假关节形成的影响。
酮咯酸是一种非甾体类抗炎药，常用于脊柱手术后的疼痛控制。使用酮咯酸的主要担忧是融合后假关节形成的风险。
对多个医学参考文献数据库进行系统检索，以查找分别详细描述成人和儿童患者腰椎融合术及脊柱侧弯手术中术后使用酮咯酸的研究。由于本研究分析的是接受不同融合方法、不同节段数量以及假关节检测方法各异的异质性患者群体，因此采用随机效应模型进行荟萃分析。观察指标为假关节形成。
总体而言，共纳入6项研究，涉及1558例患者。119例（7.6%）患者出现假关节形成。在使用酮咯酸超过2天的成人患者中观察到假关节形成[比值比（OR），3.44，95%置信区间（95%CI），1.87 - 6.36；P < 0.001]，在每日剂量≥120 mg的成人患者中（OR，2.93，95%CI，1.06 - 8.12；P = 0.039），以及在使用酮咯酸超过2天且每日剂量≥120 mg的成人患者中（OR，4.75，95%CI，2.34 - 9.62；P < 0.001）。吸烟者使用酮咯酸与假关节形成相关（OR，8.71，95%CI，2.23 - 34.0；P = 0.002）。
腰椎后外侧融合术后，成人使用酮咯酸超过2天和/或剂量≥120 mg/d与假关节形成相关。吸烟者使用酮咯酸也与假关节形成相关。
