Meta-analysis of pre-clinical studies of early decompression in acute spinal cord injury: a battle of time and pressure.
Meta-analysis of pre-clinical studies of early decompression in acute spinal cord injury: a battle of time and pressure.
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DOI：
10.1371/journal.pone.0072659
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Sena ES
中科院分区：
文献类型：
--
作者：
Batchelor PE;Wills TE;Skeers P;Battistuzzo CR;Macleod MR;Howells DW;Sena ES
尽管有许多临床前研究证明了早期减压的益处，也有少量的支持性临床研究，但在急性脊髓损伤（SCI）的治疗中使用早期减压仍然存在争议。尽管临床前文献支持早期减压的概念，但由于总体治疗效果和减压时间的不确定性，翻译受到阻碍。我们进行了荟萃分析，以检查临床前文献急性减压损伤脊髓。使用了三个数据库：PubMed、ISI Web of Science和Embase。我们的入选标准包括：（i）在不同时间间隔报告减压的有效性;（ii）动物数量;（iii）每组的平均结果和方差。使用随机效应荟萃分析，并使用荟萃回归评估研究设计特征的影响。总体而言，减压改善了35.1%的行为结果（95%CI 27.4 - 42.8; I2 = 94%，p <0.001）。未常规报告最小化偏倚的措施，设盲与较小但仍显著的获益相关。发表偏倚也可能导致疗效高估。荟萃回归分析显示了许多影响结果的因素，特别是压迫压力和持续时间（调整后的r2 = 0.204，p <0.002），压力增加和压迫持续时间延长与治疗效果降低相关。在个体研究中绘制压缩压力与导致截瘫的压缩持续时间的关系图，显示了幂律关系;高压缩力迅速导致截瘫，而伴随椎管狭窄的低压缩力导致轻瘫持续数小时。这些数据表明，早期减压改善SCI动物模型的神经行为缺陷。虽然大部分文献的内部有效性有限，但在高质量的研究中保持了获益。压迫压力与严重神经损伤发展速度的密切关系表明，损伤部位的局部压力可能是确定减压紧迫性的有用参数。
The use of early decompression in the management of acute spinal cord injury (SCI) remains contentious despite many pre-clinical studies demonstrating benefits and a small number of supportive clinical studies. Although the pre-clinical literature favours the concept of early decompression, translation is hindered by uncertainties regarding overall treatment efficacy and timing of decompression. We performed meta-analysis to examine the pre-clinical literature on acute decompression of the injured spinal cord. Three databases were utilised; PubMed, ISI Web of Science and Embase. Our inclusion criteria consisted of (i) the reporting of efficacy of decompression at various time intervals (ii) number of animals and (iii) the mean outcome and variance in each group. Random effects meta-analysis was used and the impact of study design characteristics assessed with meta-regression. Overall, decompression improved behavioural outcome by 35.1% (95%CI 27.4-42.8; I2=94%, p<0.001). Measures to minimise bias were not routinely reported with blinding associated with a smaller but still significant benefit. Publication bias likely also contributed to an overestimation of efficacy. Meta-regression demonstrated a number of factors affecting outcome, notably compressive pressure and duration (adjusted r2=0.204, p<0.002), with increased pressure and longer durations of compression associated with smaller treatment effects. Plotting the compressive pressure against the duration of compression resulting in paraplegia in individual studies revealed a power law relationship; high compressive forces quickly resulted in paraplegia, while low compressive forces accompanying canal narrowing resulted in paresis over many hours. These data suggest early decompression improves neurobehavioural deficits in animal models of SCI. Although much of the literature had limited internal validity, benefit was maintained across high quality studies. The close relationship of compressive pressure to the rate of development of severe neurological injury suggests that pressure local to the site of injury might be a useful parameter determining the urgency of decompression.
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影响因子：
3
作者：
Carlson, GD;Warden, KE;LaManna, JC
通讯作者：
LaManna, JC
DOI：
10.1016/s1529-9430(01)00029-8
发表时间：
2002-03-01
期刊：
The spine journal : official journal of the North American Spine Society
影响因子：
--
作者：
Carlson, Gregory D;Gorden, Carey
通讯作者：
Gorden, Carey
影响因子：
4.2
作者：
Batchelor, Peter E.;Kerr, Nicole F.;Howells, David W.
通讯作者：
Howells, David W.
影响因子：
2.1
作者：
Frank SA
通讯作者：
Frank SA
影响因子：
4.1
作者：
DOLAN, EJ;TATOR, CH;ENDRENYI, L
通讯作者：
ENDRENYI, L