Glassman S D, Rose S M, Dimar J R, Puno R M, Campbell M J, Johnson J R
Department of Orthopaedic Surgery, University of Louisville School of Medicine, Kentucky, USA.
Spine (Phila Pa 1976). 1998 Apr 1;23(7):834-8. doi: 10.1097/00007632-199804010-00020.
The influence of ketorolac on spinal fusion was studied in a retrospective review of 288 patients who underwent an instrumented spinal fusion.
To assess the effect of postoperative ketorolac administration on subsequent fusion rates.
Nonsteroidal anti-inflammatory drugs are widely used compounds, which are known to inhibit osteogenic activity and have been shown to decrease spinal fusion in an animal model. No previous studies have examined the influence of nonsteroidal anti-inflammatory drugs on spinal fusion in clinical practice.
The medical records of 288 patients who underwent instrumented spinal fusion from L4 to the sacrum between 1991 and 1993 were reviewed retrospectively. The 121 patients who received no nonsteroidal anti-inflammatory drugs were compared with the 167 patients who received ketorolac after surgery. The groups were demographically equivalent.
Ketorolac had a significant adverse effect on fusion, with five nonunions in the nondrug group and 29 nonunions in the ketorolac group (P > 0.001). Ketorolac administration also significantly decreased the fusion rate for subgroups including men, women, smokers, and nonsmokers. The odds ratio demonstrated that nonunion was approximately five times more likely after ketorolac administration. Cigarette smoking also decreased the fusion rate (P > 0.01); smokers were 2.8 times more likely to develop nonunion.
These data suggest that nonsteroidal anti-inflammatory drugs significantly inhibit spinal fusion at doses typically used for postoperative pain control. The authors recommend that these drugs be avoided in the early postoperative period.
通过对288例行器械辅助脊柱融合术患者的回顾性研究，探讨酮咯酸对脊柱融合的影响。
评估术后使用酮咯酸对后续融合率的影响。
非甾体类抗炎药是广泛使用的化合物，已知其会抑制成骨活性，并且在动物模型中已显示会降低脊柱融合率。此前尚无研究在临床实践中考察非甾体类抗炎药对脊柱融合的影响。
回顾性分析1991年至1993年间288例行L4至骶骨器械辅助脊柱融合术患者的病历。将121例未使用非甾体类抗炎药的患者与167例术后使用酮咯酸的患者进行比较。两组在人口统计学特征上相当。
酮咯酸对融合有显著不良影响，未用药组有5例骨不连，酮咯酸组有29例骨不连（P>0.001）。使用酮咯酸还显著降低了包括男性、女性、吸烟者和非吸烟者在内的亚组的融合率。优势比表明，使用酮咯酸后发生骨不连的可能性约为未使用时的五倍。吸烟也会降低融合率（P>0.01）；吸烟者发生骨不连的可能性是不吸烟者的2.8倍。
这些数据表明，非甾体类抗炎药在用于术后疼痛控制的典型剂量下会显著抑制脊柱融合。作者建议在术后早期避免使用这些药物。
