Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA.
Clin Neurol Neurosurg. 2020 Jun;193:105737. doi: 10.1016/j.clineuro.2020.105737. Epub 2020 Feb 17.
Heterotopic ossification(HO) is a common complication following spinal cord injury(SCI); however, its underlying pathophysiology remains relatively unknown. Although there are options for treating HO, prophylactic treatment is limited. Additionally, evidence supporting the effectiveness of these prophylactic treatments is scarce. Electronic literature search was conducted using four databases. Studies comparing prophylactic medication for HO versus placebo for patients with acute spinal cord injury were included. A meta-analysis comparing the incidence of HO between the two groups was conducted, with a subgroup analysis of non-steroidal anti-inflammatory drugs (NSAIDs) and non-NSAIDs. A total of 5 studies and 815 patients were included. Overall incidence of HO was 9.73 % (n = 25) in the medication group versus 16.5 %(n = 92) in the placebo group. However, the two groups do not statistcally differ(p = 0.21). In the subgroup analysis for NSAIDs, those who received prophylactic treatment with NSAIDs had a lower incidence of HO compared to those who received placebo (RR[95 % CI]:0.32[0.15, 0.68]; p = 0.003). As for studies that used bisphosphonates, a statistically significant difference in incidence of HO was not found (RR[95 % CI]:1.30[0.52, 3.24];p = 0.58) and the overall evidence was inconclusive. In present systematic review and meta-analysis comparing prophylactic medications to placebo for prevention of HO, we found similar incidence rates for both groups. However, subgroup analysis showed a significantly lower incidence rate for those who recevied NSAIDs for HO prophylaxis. Altough this finding is promising for secondary prevention of HO among patients suffering from SCI, further prospective studies with longer follow-ups are required to assess other appropriate medications for HO prevention.
异位骨化（HO）是脊髓损伤（SCI）后的常见并发症；然而，其潜在的病理生理学仍然相对未知。虽然有治疗 HO 的选择，但预防治疗有限。此外，支持这些预防治疗有效性的证据很少。使用四个数据库进行了电子文献检索。纳入了比较急性脊髓损伤患者预防 HO 药物与安慰剂的研究。对两组之间 HO 发生率进行了 meta 分析，并对非甾体抗炎药（NSAIDs）和非 NSAIDs 进行了亚组分析。共纳入 5 项研究 815 例患者。药物组 HO 的总发生率为 9.73%（n=25），安慰剂组为 16.5%（n=92）。然而，两组之间没有统计学差异（p=0.21）。在 NSAIDs 的亚组分析中，与安慰剂组相比，接受 NSAIDs 预防治疗的患者 HO 发生率较低（RR[95%CI]：0.32[0.15, 0.68]；p=0.003）。至于使用双膦酸盐的研究，HO 发生率无统计学差异（RR[95%CI]：1.30[0.52, 3.24]；p=0.58），总体证据不确定。在本系统评价和 meta 分析中，比较预防药物与安慰剂预防 HO 的效果，我们发现两组的发生率相似。然而，亚组分析显示，接受 NSAIDs 预防 HO 的患者发生率显著降低。尽管这一发现为 SCI 患者 HO 的二级预防提供了希望，但需要进行更长时间随访的前瞻性研究来评估其他预防 HO 的合适药物。
