Meta Analysis Of Clinical Efficacy Of Decompression Time Window In Traumatic Spinal Cord Injury

Objective:The relationship between the time window of decompression and the recovery of neurological function in traumatic spinal cord injury is still controversial.The purpose of this study is to explore the effect of early decompression on patients with traumatic spinal cord injury.Methods:PubMed(1966 to March 2021),Embase(1966 to March 2021),WebofScience(March 2021),Cochrane Library(March 2021),Chinese Biomedical Database(1979 to March 2021),VIP Information Database(1989 to March 2021),Wanfang Database(1982 to March 2021)and CNKI(1999 to March 2021)were searched by computer.To compare and analyze the curative effect of early decompression or delayed decompression in patients with traumatic spinal cord injury.The early and late decompression groups were included in different time nodes(5 hours,8 hours,12 hours,24 hours,48 hours,72 hours and 4 days).Results:29 studies met the inclusion criteria.In the early and delayed decompression groups defined by 8 hours,24 hours and 72 hours respectively,the early operation can achieve a better improvement rate of ASIA grade.Decompression of cervical spinal cord injury and thoracolumbar spinal cord injury within 8 hours can achieve a better improvement rate of ASIA grade in early decompression surgery,but the decompression group can only get better improvement of ASIA grade in thoracolumbar spinal cord injury within 24 hours.In the comparison of decompression surgery within 8 hours and 8-24 hours,decompression within 8 hours can achieve better improvement of ASIA grade.The improvement rate of postoperative ASIA motor score in the early decompression group was significantly higher than that in the delayed decompression group within 48 hours.There was no significant difference in Frankel grade between early and delayed decompression operation defined by 72 hours.The hospitalization time of the decompression group was shorter than that of the delayed decompression group within 8 hours.In the study with 24 hours as the decompression time node,there was no significant difference in the length of hospital stay.There was no significant difference in the incidence of early and delayed operative complications defined at different time nodes(8 hours,24 hours,72 hours).Conclusions:Compared with delayed operation,early surgical decompression in patients with traumatic spinal cord injury can achieve better neurological function recovery,and patients with decompression within 8 hours can achieve better neurological function recovery than patients with 8-24 hours decompression.Patients with cervical spinal cord injury can get better neurological function recovery by decompression within 8 hours,while thoracolumbar spinal cord injury can get better neurological function recovery no matter within 8 hours or within 24 hours.Patients who underwent decompression surgery within 8 hours have shorter hospital stay,and the timing of operation has no significant effect on the incidence of perioperative complications.