Leicester General Hospital, University Hospitals Leicester NHS Trust, Leicester, UK.
Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Clin Obes. 2020 Aug;10(4):e12382. doi: 10.1111/cob.12382. Epub 2020 Jun 7.
Obesity contributes to a plethora of significant chronic diseases. Bariatric surgery has been demonstrated to be the most cost-effective treatment for severe obesity and significantly reduces morbidity and mortality from metabolic syndrome. Patients with paraplegia have significantly impaired mobility and are therefore at a much higher risk of developing severe obesity and its sequelae. Bariatric surgery may bring significant improvements to mobility, morbidity and quality of life for patients with paraplegia, but evidence in the literature is poor for this group of patients.
A systematic review was conducted conforming to PRISMA guidelines. The MEDLINE and Cochrane databases were searched for all articles published prior to April 2019 matching all of the keywords 'bariatric', 'paraplegia' and 'spinal cord'. Articles were assessed for relevance and full texts reviewed. In addition, clinical records were reviewed for three patients who underwent bariatric surgery at a single UK private institution. Non-identifiable demographic, clinical, operative and outcome data were obtained from electronic records.
Twenty seven articles were retrieved from the initial database search, of which nine eligible full texts were reviewed. Eight articles were case reports or case series and the final article was a systematic review. All cases reported had positive outcomes with significant weight loss, improvement in mobility and increased quality of life. Outcomes from the three diversely aged patients in our case series were similarly positive, with no significant post-operative complications.
Patients with obesity and paraplegia may significantly benefit from bariatric surgery. There is a need for multi-centre cohort studies to evaluate outcomes and the choice of bariatric intervention. UK guidelines do not include criteria based on mobility or neurological deficit, resulting in a potential missed opportunity to offer a cost-effective treatment that can significantly improve quality of life for patients with severe obesity and paraplegia.
肥胖会导致多种严重的慢性疾病。减重手术已被证明是治疗重度肥胖症最具成本效益的方法，可显著降低代谢综合征的发病率和死亡率。截瘫患者的活动能力严重受损，因此发生重度肥胖及其并发症的风险更高。减重手术可能会显著改善截瘫患者的活动能力、发病率和生活质量，但针对这组患者的文献证据有限。
本研究按照 PRISMA 指南进行了系统回顾。检索了 MEDLINE 和 Cochrane 数据库中所有在 2019 年 4 月之前发表的符合所有关键词“减重”、“截瘫”和“脊髓”的文章。评估文章的相关性，并对全文进行审查。此外，还对一家英国私立机构进行减重手术的 3 名患者的临床记录进行了审查。从电子记录中获取了不可识别的人口统计学、临床、手术和结果数据。
从最初的数据库搜索中检索到 27 篇文章，其中 9 篇符合条件的全文进行了审查。8 篇文章是病例报告或病例系列，最后一篇是系统综述。所有报告的病例均取得了积极的结果，体重显著减轻，活动能力改善，生活质量提高。我们的病例系列中 3 名不同年龄患者的结果也同样积极，无明显术后并发症。
肥胖和截瘫患者可能会从减重手术中显著获益。需要进行多中心队列研究来评估结果和减重干预措施的选择。英国指南不包括基于活动能力或神经功能缺损的标准，导致可能错失为严重肥胖和截瘫患者提供具有成本效益的治疗方法的机会，而这种方法可以显著提高他们的生活质量。
