手术和非手术治疗成人脊柱侧弯效果比较的meta分析  

Comparison of operative and nonoperative treatment in patients with adult spinal deformity: a meta-analysis

作　　者：阿木以达 姚汝瞻 王光林[1] 毋承玺 熊巍 AMU Yida;YAO Ruzhan;WANG Guanglin;WU Chengxi;XIONG Wei(Department of Orthopedics,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P. R. China)

机构地区：[1]四川大学华西医院骨科

出　　处：《华西医学》2019年第9期986-993,共8页West China Medical Journal

基　　金：四川省科学技术厅科技计划项目(2018SZ0145,2018SZYZF0006);广安市2016年创新基金项目

摘　　要：目的系统评价手术方法与非手术方法治疗成人脊柱侧弯(adult spinal deformity,ASD)的疗效与安全性。方法计算机检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方和维普数据库,收集手术和非手术方法治疗ASD的相关对照研究,并对ClinicalTrials.gov网站进行检索以获取更多的相关研究数据,检索时限均从建库至2019年6月。由2位研究员独立进行文献检索、偏倚风险评价与数据提取,然后应用RevMan 5.3和Stata 14.0软件进行meta分析。结果共纳入10个非随机对照研究,总计1 601例患者。Meta分析结果显示,与非手术组比较,手术治疗能够更好地改善功能[脊柱侧凸研究学会22项量表改变值:加权均数差(weighted mean difference,WMD)=0.70分,95%置信区间(confidence interval,CI)(0.69,0.70)分,P<0.000 01;Oswestry功能障碍指数改变值:WMD=11.12分,95%CI(10.74,11.50)分,P<0.000 01]、缓解疼痛[数字等级评分变化值:WMD=3.25分,95%CI(3.16,3.35)分,P<0.000 01]及矫正侧弯畸形[Cobb角改变值:WMD=14.06°,95%CI(13.60,14.53)°,P<0.000 01];但手术组并发症发生率明显高于非手术组[相对危险度=5.38,95%CI(3.67,7.88),P<0.000 01]。结论手术治疗较非手术方法能够更好地改善ASD患者的功能,获得更佳的矫形效果,但手术并发症发生率较高。对于身体状况不佳、不能耐受手术的患者非手术方法也是一种有效的治疗措施。受纳入文献数量及质量限制,上述结论需更多高质量研究予以验证。Objective To systematically review the efficacy and safety of operative treatment versus nonoperative treatment in patients with adult spinal deformity (ASD). Methods PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, WanFang Data, and CQVIP databases were searched for controlled studies about operative treatment versus nonoperative treatment for ASD published up till June 2019. ClinicalTrials.gov was searched for grey literatures informally published up till June 2019. Two reviewers independently screened literatures, extracted data, and assessed risk of bias. Meta-analysis was performed by using RevMan 5.3 and Stata 14.0 softwares. Results A total of 10 non-randomized controlled studies were included, including 1 601 patients. The pooled results indicated that the operative group was superior to the nonoperative group in ability improvement [the increment of Scoliosis Research Society-22 score: weighted mean difference (WMD)=0.70, 95% confidence interval (CI)(0.69, 0.70), P<0.000 01;the decrement of Oswestry Disability Index score: WMD=11.12, 95%CI (10.74, 11.50), P<0.000 01], pain relief [the decrement of Numeric Rating Scale score: WMD=3.25, 95%CI (3.16, 3.35), P<0.000 01], and Cobb correction [WMD=14.06°, 95%CI (13.60, 14.53)°, P<0.000 01]. The incidence of complications was higher in the operative group than that in the nonoperative group [relative risk=5.38, 95%CI (3.67, 7.88), P<0.000 01]. Conclusions Surgery shows superior efficacy on ability improvement, pain relief, and Cobb correction compared with nonoperative treatment in ASD patients,though its incidence of complications is high. Nonoperative treatment is also an effective treatment for patients with poor physical condition and intolerance to surgery. Due to the limited quantity and quality of included studies, more high- quality studies are required to verify the above conclusions.

关 键 词：成人脊柱侧弯 手术治疗 非手术治疗 疗效 META分析 

分 类 号：R687.3[医药卫生—骨科学]