胸腰段脊柱结核骨折前路与后路治疗途径比较的Meta分析  

Anterior approach versus posterior approach for thoracolumbar spinal tuberculosis fracture: A Meta-analysis

作　　者：曹鹏[1] 艾克热木江.木合热木 武忠炎[1] 王新玲[1] 贾民[3] 

机构地区：[1]新疆医科大学第五附属医院骨科 [2]清华大学积水潭医院,北京市100083 [3]新疆医科大学第五附属医院重症医学科

出　　处：《中国组织工程研究》2013年第43期7594-7601,共8页Chinese Journal of Tissue Engineering Research

摘　　要：背景:在发展中国家脊柱结核的发病率仍然较高。除了进行药物治疗之外,部分患者需要进行手术治疗,但目前对脊柱结核的治疗途径尚无统一标准。目的:通过查阅与研究脊柱结核前路与后路治疗途径比较的文献,对此两种方式的效果做出系统评价。方法:通过检索Pubmed,Medline,Elseveir,万方,CNKI等数据库,以"thoracolumbar tuberculosis","controlled randomized trial","RCT","anterior""posterior","脊柱结核","前路","后路","随机对照"等关键词查找相关脊柱结核前后路治疗途径比较的病例对照研究论文,并利用Revman5.1荟萃分析软件对文献中手术时间,术中出血量,Cobb角矫正角度与末次随访丢失角度,植骨融合时间,总住院时间,疗效优良率等数据进行了系统评价。结果与结论:共检索论文1 438篇,最后筛选出符合要求的文献9篇;总病例692例,其中前路手术组324例,后路手术组368例。前路手术时间较后路手术时间平均少46.25(40.23,52.26)min,前路手术组出血量较后路手术组出血量平均少148.91(135.12,1 625.70)mL,前路手术组Cobb角矫正角度较后路手术组平均小2.40°(2.21°,4.62°),前路手术组Cobb角丢失角度较后路手术组Cobb角丢失角度平均多0.66°(0.41°,0.91°),前路手术组较后路手术组总住院时间平均少0.34(-0.32,1.01)d,前路手术组植骨融合时间较后路手术组平均少0.26(0.18,0.34)个月,前路手术组手术效果优良例数较后路手术组多1.18(-0.48,2.85)例;两组手术时间之间手术时间,术中出血量,Cobb角矫正角度与末次随访丢失角度,植骨融合时间之间有显著性差异(P<0.01),说明脊柱结核前后路方式之间手术时间、术中出血量、Cobb角矫正度数与末次随访丢失角度、植骨融合时间比较有显著区别,但二者总住院时间与手术疗效之间差异无显著性意义。BACKGROUND：There is a high prevalence of spinal tuberculosis in developing countries. Beside systematic chemotherapy, there are stil some patients who need surgical treatment at certain phase of systematic treatment. However, there is no standard method for surgical treatment of spinal tuberculosis yet. OBJECTIVE：To systematical y evaluate the effect of anterior approach and posterior approach through consulting the literatures on the comparison between anterior approach and posterior approach for the treatment of spinal tuberculosis. METHODS：The PubMed database, Medline database, Elseveir database, Wanfang database and CNKI database were searched with the key words of“thoracolumbar tuberculosis, control ed randomized trial, RCT, anterior, posterior”in Chinese and English. The randomized control ed trials on the comparison between anterior approach and posterior approach for the treatment of spinal tuberculosis were included. The operative time, intraoperative blood loss, correction degree of Cobb angle, loss of Cobb angle at final fol ow-up, al ograft fusion time, total hospital stay and the excellent and good rate of the effectiveness were compared by Revman5.1 software. RESULTS AND CONCLUSION：A total of 1 438 articles were screened out, and final y 9 randomized control ed trials were included. The total number of patients was 692, in which 324 were treated with anterior approach and 368 were treated with posterior approach. The operative time of anterior approach of 46.25（40.23, 52.26） minutes was less than that of posterior approach;the intraoperative blood loss of anterior approach of 148.91（135.12, 1 625.70） mL less than that of posterior approach;the correct degree of Cobb angle of anterior approach of 2.40°（2.21°, 4.62°） was smal er than that of posterior approach;the loss of Cobb angle of anterior approach of 0.66°（0.41°, 0.91°） was larger than that of posterior approach;the total hospital stay of anterior approach of 0.34 （-0.32,1.01） days was less than that of post

关 键 词：结核 脊柱 胸椎 腰椎 脊柱骨折 关节融合术 

分 类 号：R318[医药卫生—生物医学工程]