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背景:目前椎间盘切除、融合或减压被认为是一种有效的常规修复脊柱疾病的方法。虽然已经有大量文献报道糖尿病对脊柱手术带来不良影响,但是仍存在一定的分歧。目的:对有关糖尿病对脊柱手术并发症影响的观察性研究及病例对照性研究进行系统性评价。方法:根据纳入标准,搜索数据库选择糖尿病对脊柱手术结果及并发症影响的对控制或对比性研究,观察指标包括死亡率、翻修率、手术部位感染、静脉血栓发生率、失血量、手术时间及住院时间。2名作者分别进行文章数据的提取及纳入研究的方法学和质量评估。根据流行病学观察研究(MOOSE)的指导方针来进行Meta分析,使用RevMan 5.2软件进行提取数据的风险评估。结果与结论:共纳入18篇文献,包含有2 824 063例患者,结果显示,糖尿病患者行脊柱手术后死亡率、手术部位感染、静脉血栓发生率均较非糖尿病患者高,住院时间较非糖尿病患者长,差异有显著性意义(P<0.05);而翻修的风险、术中失血量及手术时间三者差异无显著性意义(P>0.05)。提示糖尿病患者接受脊柱手术比非糖尿病患者有更高的风险,糖尿病增加了脊柱手术后死亡率、手术部位感染、静脉血栓的风险及住院时间。
Background: Currently, discectomy, fusion or decompression is considered as an effective and routine method for the treatment of spinal diseases. Although there are a large number of reports of diabetes on the adverse effects of spinal surgery, but there are still some differences. OBJECTIVE: To systematically evaluate the observational studies and case-control studies on the effects of diabetes on the complications of spinal surgery. Methods: According to the inclusion criteria, we searched the database for the control or comparative study of the effect of diabetes on the outcome and complications of spinal surgery. The observed indexes included mortality, revision rate, surgical site infection, incidence of venous thrombosis, blood loss, operation time and Hospitalization time. Two authors extracted the article data and included the methodology and quality assessment of the study. Meta-analysis was conducted according to the guidelines of the epidemiological observational study (MOOSE) and RevMan 5.2 software was used to assess the risk of extracting data. RESULTS AND CONCLUSION: A total of 18 articles were included in the study, including 2 824 063 patients. The results showed that the mortality rate, operation site infection and venous thromboembolism rate of diabetic patients after spine surgery were higher than those of non-diabetic patients and hospital stay was longer than that of non-diabetic patients There was significant difference between the two groups (P <0.05). There was no significant difference in the risk of revision, blood loss during operation and operation time (P> 0.05). It suggested that patients with diabetes underwent spine surgery at a higher risk than non-diabetic patients. Diabetes increased the post-operative mortality rate, surgical site infection, risk of venous thrombosis, and hospital stay.