Early excision and late excision of heterotopic ossification after traumatic brain injury are equivalent: A systematic review of the literature
Early excision and late excision of heterotopic ossification after traumatic brain injury are equivalent: A systematic review of the literature
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DOI：
10.1089/neu.2007.0342
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发表时间：
2007-11-01
影响因子：
4.2
通讯作者：
Giannoudis, Peter V.
中科院分区：
文献类型：
--
作者：
Chalidis, Byron;Stengel, Dirk;Giannoudis, Peter V.
异位骨化（HO）是脑外伤昏迷患者常见的并发症。由于手术切除的最佳时机仍有争议且不明确，因此进行了文献综述，以确定早期手术对复发率和关节活动度的影响。我们在主要的医学和出版商的数据库中找到了所有类型的关于脑损伤后手术切除HO的研究。通过漏斗图不对称性和Galbraith回归评估发表偏倚和统计异质性。我们从将个体患者数据（IPD）制成表格的手稿中提取人口统计学和结局信息，以建立单变量逻辑和线性回归模型。还获得了随机效应荟萃回归分析的平均值和比例。在最初确定的318项研究中，16项观察性研究纳入了255例患者（212例男性，329个受累关节，平均年龄30.6[+/- SEM为1.4]岁）。11项研究报告的总体复发率为38/192（19.8%）。IPD和荟萃回归分析均未显示切除间隔对复发概率的显著影响（比值比1.00，95%CI 0.98-1.03）。在等待13个月、21个月和30个月后的预测复发概率分别为9%、14%和19%。昏迷时间和患者的神经功能缺损是复发率和功能结局的统计学显著负预测因子。虽然没有结论性的推论可以从确定的研究，现有的数据不支持的概念，早期切除触发以后复发。
Heterotopic ossification (HO) is a common complication in patients with coma after brain injury. As the optimal timing of surgical resection is still controversial and unclear, a review of the literature was performed in order to determine the impact of early operation on recurrence rate and joint mobility. We identified all types of studies dealing with surgical excision of HO in patients after head injury in major medical and publishers' databases. Publication bias and statistical heterogeneity were assessed by funnel-plot asymmetry and Galbraith regression. We abstracted demographic and outcome information from manuscripts that tabulated individual patient data (IPD) to build univariate logistic and linear regression models. Means and proportions for random-effects meta-regression analysis were also obtained. Of 318 studies originally identified, 16 observational studies enrolling 255 patients (212 men, 329 affected joints, mean age of 30.6[+/- SEM of 1.4] years) were included in the analysis. The reported overall recurrence rate in eleven studies was 38/192 (19.8%). Both IPD and meta-regression analysis failed to show a marked impact of the interval to resection on the probability of recurrence (odds ratio 1.00, 95% CI 0.98-1.03). The predicted probability of recurrence after 13, 21, and 30 months of waiting was 9%, 14%, and 19%, respectively. The length of coma period and patient's neurologic deficit were statistically significant negative predictors for both recurrence rate and functional outcome. Although no conclusive inferences can be drawn from the identified studies, the available data do not support the concept that early excision triggers later recurrence.