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脊柱外科中的类风湿性关节炎：一项系统评价与荟萃分析

Rheumatoid Arthritis in Spine Surgery: A Systematic Review and Meta-Analysis.

作者信息

Streufert Benjamin D, Onyedimma Chiduziem, Yolcu Yagiz U, Ghaith Abdul Karim, Elder Benjamin D, Nassr Ahmad, Currier Bradford, Sebastian Arjun S, Bydon Mohamad

机构信息

Department of Orthopedic Surgery, 6915Mayo Clinic, Rochester, MN, USA.

Department of Neurological Surgery, 6915Mayo Clinic, Rochester, MN, USA.

出版信息

Global Spine J. 2022 Sep;12(7):1583-1595. doi: 10.1177/21925682211057543. Epub 2022 Mar 18.

DOI:10.1177/21925682211057543
PMID:35302407
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9393968/
Abstract

STUDY DESIGN

Systematic Review and Meta-analysis.

OBJECTIVE

The purpose of this study is to synthesize recommendations for perioperative medical management of RA patients and quantify outcomes after spine surgery when compared to patients without RA.

METHODS

A search of available literature on patients with RA and spine surgery was performed. Studies were included if they provided a direct comparison of outcomes between patients undergoing spine surgery with or without RA diagnosis. Meta-analysis was performed on operative time, estimated blood loss, hospital length of stay, overall complications, implant-related complications, reoperation, infection, pseudarthrosis, and adjacent segment disease.

RESULTS

Included in the analysis were 9 studies with 703 patients with RA undergoing spine surgery and 2569 patients without RA. In RA patients compared to non-RA patients undergoing spine surgery, the relative risk of infection was 2.29 times higher (P = .036), overall complications 1.61 times higher (P < .0001), implant-related complications 3.93 times higher (P = .009), and risk of reoperation 2.45 times higher (P < .0001). Hospital length of stay was 4.6 days longer in RA patients (P < .0001).

CONCLUSIONS

Treatment of spinal pathology in patients with RA carries an increased risk of infection and implant-related complications. Spine-specific guidelines for perioperative management of antirheumatic medication deserve further exploration. All RA patients should be perioperatively co-managed by a rheumatologist. This review helps identify risk profiles in RA specific to spine surgery and may guide future studies seeking to medically optimize RA patients perioperatively.

摘要

研究设计

系统评价与荟萃分析。

目的

本研究旨在综合类风湿关节炎（RA）患者围手术期医疗管理的建议，并与非RA患者相比，量化脊柱手术后的结局。

方法

检索关于RA患者和脊柱手术的现有文献。纳入的研究需提供对有或无RA诊断的脊柱手术患者结局的直接比较。对手术时间、估计失血量、住院时间、总体并发症、植入物相关并发症、再次手术、感染、假关节形成和相邻节段疾病进行荟萃分析。

结果

分析纳入了9项研究，其中703例RA患者接受了脊柱手术，2569例非RA患者接受了脊柱手术。与接受脊柱手术的非RA患者相比，RA患者感染的相对风险高2.29倍（P = .036），总体并发症高1.61倍（P < .0001），植入物相关并发症高3.93倍（P = .009），再次手术风险高2.45倍（P < .0001）。RA患者的住院时间长4.6天（P < .0001）。

结论

RA患者脊柱病变的治疗存在感染和植入物相关并发症风险增加的情况。抗风湿药物围手术期管理的脊柱特异性指南值得进一步探索。所有RA患者围手术期均应由风湿病学家共同管理。本综述有助于确定RA患者脊柱手术特有的风险特征，并可能指导未来旨在在围手术期对RA患者进行医学优化的研究。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/db4e/9393968/2d91d663c169/10.1177_21925682211057543-fig10.jpg
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