前路与后路选择性融合治疗Lenke 5型青少年特发性脊柱侧凸的Meta分析研究  

Anterior versus Posterior Spinal Selective Fusion Approaches in Treating Lenke Type 5 Adolescent Idiopathic Scoliosis:A Meta-Analysis

作　　者：梁伟时 海涌[1] 韩渤 孙端 尹鹏 LIANG Wei-shi;HAI Yong;HAN Bo;SUN Duan;YIN Peng(Department of Orthopaedic Surgery,Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院骨科,北京100020

出　　处：《骨科》2023年第1期27-33,共7页ORTHOPAEDICS

摘　　要：目的比较选择性前路脊柱融合术(anterior spinal fusion,ASF)和后路脊柱融合术(posterior spinal fusion,PSF)治疗Lenke 5型青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)的影像学和临床指标差异。方法在PubMed、Embase、Cochrane Library、Web of Science四个文献数据库进行系统文献检索。采用Meta分析的方法比较ASF与PSF治疗后胸腰/腰弯、胸弯的矫正度数及其他重要影像学和临床指标的变化。结果本研究共纳入15项研究,包括505例ASF病人和467例PSF病人。PSF组的术后胸弯代偿性矫正度数明显大于ASF组,差异有统计学意义(P<0.05),但两组末次随访时的数据未见明显差异(P>0.05)。ASF与PSF组在术后和末次随访时的胸腰/腰弯矫正度数、末次随访时的躯干偏移距离及术中出血量比较,差异均无统计学意义(P>0.05)。与PSF组比较,ASF组的融合节段较少,但手术时间较长,组间比较,差异有统计学意义(P<0.05)。结论在长期随访过程中,ASF具有与PSF相似的冠状位弯曲和平衡的矫正效果,且融合节段较少。医生应根据病人畸形的严重程度和手术技术水平,选择合适的手术入路。Objective To compare the radiographical and clinical outcomes between selective anterior spinal fusion(ASF)and posterior spinal fusion(PSF)in Lenke type 5 adolescent idiopathic scoliosis(AIS).Methods A systematic literature search was conducted in PubMed,Embase,Cochrane Library and Web of Science for relevant studies.Correction degree of thoracolumbar/lumbar(TL/L)and thoracic curves,along with other essential radiographical and clinical outcomes between ASF and PSF,were compared in the metaanalysis.Results A total of 505 ASF patients and 467 PSF patients from 15 studies were included.The ASF group showed more postoperative compensatory correction degree of the thoracic curve than the PSF group(P<0.05),however,no statistically significant differences were found at the final follow-up(P>0.05).There was no significant difference in the correction degree of TL/L curves at the post-operation and at the final follow-up,trunk shift(TS)distance at the final follow-up and the blood loss between ASF and PSF(P>0.05).Moreover,ASF showed fewer fusion segments but longer operation time(P<0.05).Conclusion ASF could achieve an approximate correction effect of coronal curve and balance as PSF with fewer fusion segments in long-term followup-The surgeons should choose the appropriate surgical approach according to the severity of the patient’s deformity and the surgical technique level.

关 键 词：青少年特发性脊柱侧弯 Lenke 5型 前路脊柱融合术 后路脊柱融合术 Meta分析 

分 类 号：R687.3[医药卫生—骨科学]