C5的危险因素:系统审查和多变量分析
Vincent C Traynelis1, Ricardo B V Fontes1, Manish K Kasliwal2
11Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois.
Journal of neurosurgery. Spine
|November 17, 2023
概括
在宫脊椎手术中,术后C5的风险随着体直径的减少而增加. 减少前后直径也会增加风险,尽管证据不太清楚.
科学领域:
- 神经外科 神经外科
- 整形外科手术 整形外科手术
- 脊柱外科手术 脊柱外科手术
背景情况:
- 手术后C5 (C5P) 是宫脊椎手术后的一种并发症.
- 对于C5P的确切病理生理学仍然不太了解.
- 识别风险因素对于患者管理和手术规划至关重要.
研究的目的:
- 系统地审查关于C5P的现有文献.
- 批判性地评估有关C5P风险因素的证据.
- 确定手术前解剖因素与C5P之间的关联.
主要方法:
- 在PubMed,EMBASE和Cochrane数据库中的系统文献搜索 (截至2021年7月).
- 包括分析手术前前直径 (FD),前后直径 (APD),脊髓转移,旋转和科布角度的研究.
- 使用预测研究中的质量 (QUIPS) 工具进行质量评估,并使用推评估,开发和评估 (GRADE) 的评级进行证据强度评估.
主要成果:
- 中等质量的证据表明,手术前的FD在宫后部手术中显著增加了C5P几率.
- 在手术前的FD每毫米下降,C5P几率就会增加三倍 (OR3.05).
- 术前APD下降显示出不太明显的关联,每毫米的下降都与C5P几率增加2倍 (OR 2.51) 相联系.
结论:
- 前狭窄明显与C5P有关,特别是在宫后部手术中.
- 缩小前后直径也与C5P有关,但这种关联不那么明确.
- 对大多数已识别的风险因素的证据质量低至非常低.
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