脊柱截骨短缩致脊髓血流量变化对脊髓保护性和安全性影响的荟萃分析

Meta analysis of effects on spinal cord protection and safety of changes in spinal cord blood flow(SCBF) caused by spinal osteotomy

中文关键词:  脊柱截骨术  脊柱畸形  脊柱短缩  脊髓血流量  脊髓诱发电位  荟萃分析

英文关键词:Spinal osteotomy  Spinal deformity  Spinal shortening  Spinal cord blood flow  Spinal cord evoked potential  Meta analysis

中文摘要:

  【摘要】 目的：系统评价脊柱截骨短缩导致脊髓血流量（spinal cord blood flow，SCBF）的变化及其对脊髓的影响，探究截骨短缩的安全范围。方法：计算机检索2024年5月之前在中国知网、万方、维普、PubMed、Cochrane Library、EMBASE和CBM等数据库发表的有关脊柱截骨短缩后SCBF变化的相关研究文献，由2位研究人员独立进行文献筛选及资料提取（包括研究设计、样本量及结局指标等），并综合运用改良后的Jadad评分量表和纽卡斯尔-渥太华量表（Newcastle-Ottawa scale，NOS）对纳入文献进行质量评价，使用Revman 5.3软件进行荟萃分析。结果：共纳入8篇文献，通过Cochrane风险偏倚评估工具评价，纳入文献的风险主要源自分配隐藏和结局盲法；综合6篇随机对照研究的Jadad量表评分和2篇队列研究NOS量表评分均≥5分，总计纳入170个研究对象，其中犬91只，兔50只，临床患者29例。在犬和兔的动物实验中，犬脊柱椎体短缩2/4较短缩1/3或1/4时SCBF有所增加[OR=-24.10，95% CI（-35.96，-12.23），Z=3.98，P<0.0001]；犬脊柱椎体短缩2/3或3/4较短缩2/4时SCBF明显减少[OR=44.63，95% CI（19.16，70.09），Z=3.43，P=0.0006]，且出现明显的脊髓诱发电位（spinal cord-evoked potentials，SCEP）异常；脊柱椎体短缩2/3或3/4较短缩1/3或1/4时SCEP明显异常[OR=0.03，95%CI（0.00，0.21），Z=3.55，P=0.0004]；兔脊柱椎体短缩超过2/4时硬膜囊迂曲角明显增大[OR=53.51，95%CI（17.92，89.10），Z=2.95，P=0.003]，进而导致SCBF急剧减少，差异显著且具有统计学意义。在临床研究中，脊柱椎体短缩不超过2/4，即切除间隙约2/4较全脊椎切除术（vertebral column resection，VCR）后SCBF略有增高[OR=43.81，95%CI（20.40，67.21），Z=3.67，P=0.002]，差异具有显著统计学意义。结论：在犬、兔的动物实验和临床研究中，脊柱椎体短缩不超过2/4是截骨短缩的安全范围；在犬的动物实验中，短缩超过2/3或3/4时会导致SCBF急剧减少，引起明显的SCEP异常。

英文摘要:

  【Abstract】 Objectives: To systematically evaluate the effects of spinal osteotomy and spinal cord blood flow(SCBF) on the spinal cord, and to explore the safe range of osteotomy. Methods: The relevant research literatures on spinal osteotomy shortening and SCBF in CNKI, Wanfang, VIP, PubMed, Cochrane Library, EMBASE and CBM databases published before May 2024 were searched by computer. Two researchers independently conducted literature screening and extracted data(research design, sample size, and outcome indicators). The quality of the included literatures was evaluated by using the improved Jadad score scale and Newcastle-Ottawa scale(NOS) score. The Revman 5.3 software was used for meta-analysis. Results: A total of 8 literatures were included, and the risk of the included literatures mainly came from the allocation hiding and outcome blind methods after evaluated with the Cochrane risk bias assessment tool; The Jadad scale scores of the 6 randomized controlled studies and the NOS scores of the 2 cohort studies were all≥5. A total of 170 subjects were included, including 91 dogs, 50 rabbits, and 29 clinical patients; In the animal experiments of dogs, the SCBF increased when the spinal vertebrae were shortened by 2/4 compared with 1/3 or 1/4[OR= -24.10, 95%CI(-35.96, -12.23), Z=3.98, P<0.0001]; The SCBF in dogs decreased when the spinal vertebrae were shortened by 2/3 or 3/4 compared with 2/4[OR=44.63, 95%CI(19.16, 70.09), Z=3.43, P=0.0006]; Spinal cord evoked potentials(SCEP) was significantly abnormal when spinal vertebrae shortening was 2/3 or 3/4 compared with 1/3 or 1/4[OR=0.03, 95%CI(0.00, 0.21), Z=3.55, P=0.004]; The dural sac tortuous angle increased significantly when the spinal vertebrae shortening in rabbits was more than 2/4[OR=53.51, 95%CI(17.92, 89.10), Z=2.95, P=0.003], which led to a sharp decrease in SCBF, and the difference was statistically significant. In clinical studies, the SCBF after spinal vertebrae shortening of less than 2/4, that was, about 2/4 of the resection space, was slightly higher than that after vertebral column resection(VCR) [OR=43.81, 95%CI(20.40, 67.21), Z=3.67, P=0.002], and the difference was statistically significant. Conclusions: In animal experiments in dogs and rabbits and clinical studies, spinal vertebrae shortening of less than 2/4 is the safe range of osteotomy; In the animal experiment of dogs, when the shortening is more than 2/3 or 3/4, it will lead to a sharp decrease in SCBF and cause obvious SCEP abnormalities.