胸腰段爆裂骨折融合与非融合手术方式的Meta分析  

Metal analysis of fusion or nonfusion fixation for thoracolumbar burst fractures

作　　者：梅铁牛[1] 罗飞[1] 侯天勇[1] 张泽华[1] 李志强[1] 

机构地区：[1]第三军医大学附属西南医院骨科,全军矫形外科中心,重庆400038

出　　处：《中华创伤杂志》2012年第6期488-495,共8页Chinese Journal of Trauma

摘　　要：目的比较植骨融合内固定术与非融合内固定术治疗胸腰段爆裂骨折的临床治疗结果。方法检索PubMed、ScienceDirect、Medline、CNK!等数据库，获得2012年3月以前植骨融合内固定术（融合组）与非融合内固定术（非融合组）治疗胸腰段爆裂骨折的临床对照研究。对纳入的文献进行质量评价，提取资料并用RevMan5．1对各研究结果进行合并，计量资料以均值差及双侧95％可信区间（CI）作为效应尺度进行分析，计数资料采用比值比（oddsratio，OR）及双侧95％CI作为效应尺度进行分析，部分资料通过手动合并完成。结果检索获得相关临床对照研究英文文献8篇，中文文献1篇，相关Meta分析2篇，剔除1篇重复性研究。Meta分析结果表明，两组在后凸角矫正、术后椎体高度矫正及矫正丢失、术后神经功能改善、并发症发病率、住院时间等方面差异均无统计学意义，非融合组后凸角矫正丢失较融合组严重，而术中失血量、手术时间明显低于融合组。结论对于部分胸腰段爆裂骨折，非融合内固定术在解除压迫、重建脊柱稳定性及预防并发症等方面与植骨融合内固定术具有相似的疗效，但显著减少了术中失血量和手术时间，并可通过取出内固定恢复固定节段的运动功能、减少邻近节段退变，从而更有利于提高患者的生活质量。Objective To evaluate the efficacy of internal fixation with or without fusion in the treatment of thoracolumbar burst fractures. Methods Clinical controlled trails related to the application of pedicle screw instrumentation with Or without fusion for thoracolumbar fractures before March, 2012 were obtained by searching PubMed, Science Direct, Medline and CNKI. Quality evaluation was made on the included literature, from which data were extracted to integrate various research results by using Rev- Man 5.1. The quantitative data were analyzed based on the effect scale of mean difference （MD） and bi- lateral 95% confidence interval （CI）. The numeration data were analyzed in the use of effect scale of odds ratio （OR） and bilateral 95 % CI. The merging of some data was manually completed. Results After retrieving, eight English and one Chinese papers of the clinical controlled trials, and two related Meta analysis were obtained. With exclusion of one repetitive research, eight papers were involved in the review. Meta analysis demonstrated that fusion and non-fusion fixation had no significant differences in as- pects of correction of kyphotic angle, correction and correction loss of vertebral body height, neurological function improvement, complication rate, and length of hospital stay. While compared with the fusion fix- ation, non-fusion fixation showed a more serious correction loss of kyphotic angle, a fewer blood loss and a shorter operation time. Conclusions Non-fusion fixation shows the similar efficacy with fusion fixa- tion in the treatment of some thoracolumbar burst fractures pertaining to releasing compression, restoring spinal stability and preveming complications, but it can also significantly decrease operation time and bloodloss. Furthermore, non-fusion fixation may markedly improve patients＇ quality of life since it restores mo- tion of the instrumented segment after removal of implant and decreases the risk of adjacent segmental de- generation.

关 键 词：胸椎 腰椎 脊柱融合术 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]