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当前加速康复外科(ERAS)在脊柱手术中的获益状况:文献系统评价。

Current state of benefits of Enhanced Recovery After Surgery (ERAS) in spinal surgeries: A systematic review of the literature.

机构信息

Humanitas University, Via Rita Levi Montalcini, Pieve Emanuele (MI), Italy; Department of Neurosurgery, Humanitas Clinical and Research Center, Rozzano (MI), Italy.

Humanitas University, Via Rita Levi Montalcini, Pieve Emanuele (MI), Italy.

出版信息

Neurochirurgie. 2022 Jan;68(1):61-68. doi: 10.1016/j.neuchi.2021.04.007. Epub 2021 Apr 24.

Abstract

INTRODUCTION

Recent years have been characterized by a great technological and clinical development in spine surgery. In particular, enhanced recovery after surgery (ERAS) programs, started to gain interest also in this surgical field. Here we tried to analyse the current state of art of ERAS technique in spine surgery.

MATERIAL AND METHOD

A systematic review of the literature has been performed in order to find all the possible inclusions. Using the PRISMA guidelines, a search of the PubMed/Medline, Web of Science, Cochrane Reviews, Embase, Medline databases was conducted to identify all full-text articles in the English-language literature describing the use of ERAS programs or techniques for spine surgery in adult patients.

RESULTS

Out of the 827 studies found, only 21 met the inclusion criteria has been retained to be included in the present study. The most frequently benefits of ERAS protocols were shorter hospitalisations (n=15), and decreased complication rates (n=8) lower postoperative pain scores (n=4). These benefits were seen in the 3 main categories considered: lumbar spine surgeries, surgeries for correction of scoliosis or deformity, and surgeries of the cervical spine.

CONCLUSION

There are an arising amount of data showing that the use of ERAS programs could be helpful in reducing the days of hospitalizations and the number of complications for certain spinal procedures and in a highly selected group of patients. Despite the large interest on the topic; there is an important lack of high level of scientific evidences. Because of that, there is the need to encourage the design and creation of new randomized clinical trials that will validate the present findings.

摘要

简介

近年来,脊柱外科领域在技术和临床方面取得了巨大的发展。特别是,术后加速康复(ERAS)方案也开始在这一外科领域受到关注。在此,我们试图分析脊柱外科中 ERAS 技术的现状。

材料与方法

系统检索文献,以寻找所有可能的纳入内容。使用 PRISMA 指南,对 PubMed/Medline、Web of Science、Cochrane Reviews、Embase、Medline 数据库进行检索,以查找所有以英文发表的描述成人患者脊柱外科中使用 ERAS 方案或技术的全文文章。

结果

在 827 项研究中,仅有 21 项符合纳入标准,被保留纳入本研究。ERAS 方案最常带来的益处是住院时间缩短(n=15)和并发症发生率降低(n=8)以及术后疼痛评分降低(n=4)。这些益处见于 3 个主要考虑的类别:腰椎手术、脊柱侧凸或畸形矫正手术以及颈椎手术。

结论

越来越多的数据表明,在某些脊柱手术中,使用 ERAS 方案有助于减少住院天数和并发症的发生,且对高度选择的患者群体更有益。尽管对此主题的兴趣浓厚,但科学证据水平仍存在重要不足。因此,有必要鼓励设计和创建新的随机临床试验,以验证目前的发现。

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