Purnomo Alexander Erick, Arjuna Yang Yang Endro, Tobing Jephtah Furano Lumban, Siahaan Yusak Mangara Tua
Departement of Medicine, Faculty of Medicine, Pelita Harapan University, Tangerang, Indonesia.
Department of Orthopaedics and Traumatology, Faculty of Medicine, Pelita Harapan University, Tangerang, Indonesia.
Asian Spine J. 2024 Dec;18(6):875-888. doi: 10.31616/asj.2024.0271. Epub 2024 Dec 24.
The purpose of this systematic review and meta-analysis is to evaluate the safety and efficacy of anti-inflammatory-impregnated gelatin sponges in spine surgeries. Gelatin sponges are increasingly used as delivery vehicles for anti-inflammatory and analgesic drugs during spine surgeries. However, concerns about their safety and efficacy persist. A comprehensive literature search was conducted to identify original research articles investigating the use of anti-inflammatory-impregnated gelatin sponges in spine surgeries from 2006 to 2024. Case reports, case series, animal studies, cadaveric studies, and abstract-only articles were excluded. The risk of bias was assessed using Cochrane Risk of Bias 2.0 (Cochrane, UK) for randomized controlled trials (RCTs) and the Newcastle Ottawa Scale (NOS) for observational studies. Meta-analysis was performed using Cochrane Review Manager Web. Thirteen studies (six RCTs, six cohort studies, and one case-control study) were included. Pooled analysis revealed a significant decrease in Visual Analog Scale (VAS) score for back pain (mean difference [MD], -0.62; 95% confidence intervals [CI], -0.78 to -0.46; p<0.00001), VAS score for leg pain (MD, -0.60; 95% CI, -0.87 to -0.34; p<0.00001), and length of hospital stay (MD, -0.99; 95% CI, -1.68 to -0.31; p=0.0004). Additionally, there was a significant increase in the Japanese Orthopedic Association score (MD, 0.98; 95% CI, 0.00 to 1.96; p=0.05). However, no significant difference was observed in the disability index (MD, -0.59; 95% CI, -1.88 to -0.70; p=0.37). The use of anti-inflammatory-impregnated gelatin sponges during spine surgeries decreases postoperative back pain and leg pain, reduces length of stay, and improves neurological function. Larger, prospective, randomized trials are required to obtain more robust evidence.
本系统评价和荟萃分析的目的是评估抗炎浸渍明胶海绵在脊柱手术中的安全性和有效性。明胶海绵在脊柱手术中越来越多地用作抗炎和镇痛药的载体。然而，对其安全性和有效性的担忧依然存在。进行了全面的文献检索，以确定2006年至2024年期间研究抗炎浸渍明胶海绵在脊柱手术中应用的原始研究文章。排除病例报告、病例系列、动物研究、尸体研究和仅摘要的文章。对于随机对照试验（RCT），使用Cochrane偏倚风险2.0（英国Cochrane）评估偏倚风险；对于观察性研究，使用纽卡斯尔渥太华量表（NOS）评估。使用Cochrane系统评价管理软件进行荟萃分析。纳入了13项研究（6项RCT、6项队列研究和1项病例对照研究）。汇总分析显示，背痛视觉模拟量表（VAS）评分显著降低（平均差值[MD]，-0.62；95%置信区间[CI]，-0.78至-0.46；p<0.00001），腿痛VAS评分（MD，-0.60；95%CI，-0.87至-0.34；p<0.00001），以及住院时间（MD，-0.99；95%CI，-1.68至-0.31；p=0.0004）。此外，日本骨科协会评分显著增加（MD，0.98；95%CI，0.00至1.96；p=0.05）。然而，在残疾指数方面未观察到显著差异（MD，-0.59；95%CI，-1.88至-0.70；p=0.37）。脊柱手术中使用抗炎浸渍明胶海绵可减轻术后背痛和腿痛，缩短住院时间，并改善神经功能。需要更大规模的前瞻性随机试验来获得更有力的证据。
