胸腰椎骨折手术3种椎弓根螺钉内固定方法比较的Meta分析  

Comparison of pedicle screw fixation for thoracolumbar fractures from three approaches:a meta-analysis

作　　者：宗路杰 郝跃峰[2] 刘毅[2] 袁振 ZONG Lujie1,HAO Yuefeng2,LIU Yi2,YUAN Zhen2(1.Medical College of Soochow University,Suzhou 215000,China;2Department of Orthopedics,Suzhou Municipal Hospital,Suzhou 215000,Chin)

机构地区：[1]苏州大学医学部,215000 [2]苏州市立医院骨科,215000

出　　处：《国际骨科学杂志》2018年第3期169-179,共11页International Journal of Orthopaedics

摘　　要：目的系统评价胸腰椎骨折椎弓根螺钉内固定手术3种手术方式:后正中入路开放手术、椎旁入路开放手术、经皮手术的疗效。方法计算机检索Medline、PubMed、EMbase数据库和中国生物医学文献数据库(CBM),文献发表时间为1982年1月至2017年6月,并检索The Cochrane Library(2017年第6期)。并由2位研究者独立筛选文献、提取数据和评价研究质量,采用Rev Man 5.3软件进行Meta分析。结果最终纳入5项随机对照试验和15项观察性研究,共1 112例患者。Meta分析的结果显示:与后正中入路开放手术组相比,经皮手术组手术时间更少。与开放手术组相比,经皮手术组手术切口更小、术中出血量更少、住院时间更短,但术中X线暴露时间更长。与后正中入路开放手术组相比,经皮手术组术后1周及术后3个月疼痛视觉模拟评分(VAS)均更低,末次随访Oswestry残疾指数更低,而该3项指标,经皮手术组与椎旁入路开放手术组相比则无差异。与开放手术组相比,经皮手术组Cobb角矫正度更低、椎体前缘高度比更小,但经皮手术组的Cobb角矫正度丢失更低。经皮手术组与开放手术组的置钉错位率和术后感染率均无差异。以上结果均有统计学意义。结论对于无神经症状的胸腰椎骨折患者,经皮手术与椎旁入路开放手术的疗效相当,相比于传统后正中入路开放手术具有手术创伤小、术后疼痛轻的优点,但需严格掌控适应证,且经皮手术与椎旁入路开放手术均不推荐用于有神经症状的患者。Objective This systematic review evaluated and compared the outcomes of pedicle screw fixation for the treatment of thoracolumbar fractures from three approaches,including posterior midline,paraspinal and percutaneous approaches.Methods We conducted online searches in the database of Medline（January 1982 to June 2017）,Pubmed（January 1982 to June 2017）,Cochrane（6 th issue,2017）,Embase（January 1982 to June 2017）and China Biology Medicine（January 1982 to June 2017）.Two investigators independently screened the literatures according to the inclusion criteria,extracted data and evaluated the quality of studies.The software Rev Man 5.3 was used for meta-analysis.Results A total of 1 112 patients in 5 randomized controlled trials and 15 observational studies were finally included.Results of meta-analysis showed that compared with the traditional posterior midline approach,the percutaneous approach was associated with significantly shorter duration of operation.Compared with the open approaches,the percutaneous approach had significantly shorter incision,less blood loss,shorter hospital stay,but needed significantly more intraoperative fluoroscopy exposure.Compared with the posterior midline approach,the percutaneous surgery group had significantly lower VAS at 1 week and 3 months postoperatively,and the ODI was significantly lower at the last follow-up,while no difference was found between percutaneous approach and paraspinal approach in terms of those 3 parameters.Compared with the open surgery groups,both the Cobb angle correction and the anterior height of the vertebral bodies in the percutaneous surgery group were significantly smaller,but the loss of Cobb angle correction was also significantly lower.No significant difference was found in terms of screw misplacement rate and postoperative infection rate between the percutaneous and the open approach.Conclusion In terms of pedicle screw fixation of thoracolumbar fractures without neurologic deficit,paraspinal approach and percutaneous approach is

关 键 词：胸腰椎骨折 椎弓根螺钉 经皮 椎旁入路 META分析 

分 类 号：R687.3[医药卫生—骨科学]