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腰椎类固醇注射与脊柱手术后感染风险:一项系统评价与荟萃分析

Lumbar Spinal Steroid Injections and Infection Risk after Spinal Surgery: A Systematic Review and Meta-Analysis.

作者信息

Patel Harshadkumar A, Cheppalli Naga Suresh, Bhandarkar Amit Wasudeo, Patel Vidhi, Singla Anuj

机构信息

Department of Orthopaedic Surgery, Westchester Medical Center, Valhalla, NY, USA.

Department of Orthopaedics and Rehabilitation, University of New Mexico, VA Hospital, Albuquerque, NM, USA.

出版信息

Asian Spine J. 2022 Dec;16(6):947-957. doi: 10.31616/asj.2021.0164. Epub 2022 Mar 8.

Abstract

Lumbar spinal steroid injections (LSSI) are universally used as preferred diagnostic or therapeutic treatment options before major spinal surgeries. Some recent studies have reported higher risks of surgical-site infection (SSI) for spinal surgeries performed after injections, while others have overlooked such associations. The purpose of this study is to systematically review the literature and perform a meta-analysis to evaluate the associations between preoperative LSSI and postoperative infection following subsequent lumbar decompression and fusion procedures. Three databases, namely PubMed, Scopus, and Cochrane Library, were searched for relevant studies that reported the association of spinal surgery SSI with spinal injections. After the comprehensive sequential screening of the titles, abstracts, and full articles, nine studies were included in a systematic review, and eight studies were included in the meta-analysis. Studies were critically appraised for bias using the validated MINOR (methodological index for non-randomized studies) score. The odds ratio (OR) and 95% confidence interval (CI) were calculated. Subgroup analysis was performed according to the time between LSSI and surgery and the type of lumbar spine surgery. Meta-analysis showed that preoperative LSSI within 30 days of lumbar spine surgery was associated with significantly higher postoperative infection compared with the control group (OR,1.79; 95% CI, 1.08-2.96). Based on subgroup analysis, lumbar spine fusion surgery within 30 days of preoperative LSSI was associated with significantly high-infection rates (OR, 2.67; 95% CI, 2.12-3.35), while no association was found between preoperative LSSI and postoperative infection for lumbar spine decompression surgeries. In summary, given the absence of high-level studies in the literature, careful clinical interpretation of the results should be performed. The overall risk of SSI was slightly higher if the spinal surgery was performed within 30 days after LSSIs. The risk was higher for lumbar fusion cases but not for decompression-only procedures.

摘要

腰椎类固醇注射(LSSI)被广泛用作主要脊柱手术前的首选诊断或治疗选择。最近一些研究报告称,注射后进行脊柱手术的手术部位感染(SSI)风险较高,而其他一些研究则忽略了这种关联。本研究的目的是系统回顾文献并进行荟萃分析,以评估术前LSSI与随后腰椎减压融合手术后感染之间的关联。检索了三个数据库,即PubMed、Scopus和Cochrane图书馆,以查找报告脊柱手术SSI与脊柱注射关联的相关研究。在对标题、摘要和全文进行全面的顺序筛选后,9项研究被纳入系统评价,8项研究被纳入荟萃分析。使用经过验证的MINOR(非随机研究方法学指数)评分对研究的偏倚进行严格评估。计算比值比(OR)和95%置信区间(CI)。根据LSSI与手术之间的时间以及腰椎手术类型进行亚组分析。荟萃分析表明,与对照组相比,腰椎手术前30天内进行的术前LSSI与术后感染显著相关(OR,1.79;95%CI,1.08-2.96)。基于亚组分析,术前LSSI后30天内进行的腰椎融合手术与高感染率显著相关(OR,2.67;95%CI,2.12-3.35),而术前LSSI与腰椎减压手术的术后感染之间未发现关联。总之,鉴于文献中缺乏高水平研究,应对结果进行谨慎的临床解读。如果在LSSI后30天内进行脊柱手术,SSI的总体风险略高。腰椎融合病例的风险较高,但仅减压手术的风险不高。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cf49/9827202/654123f16ef8/asj-2021-0164f1.jpg

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