后路与一期前后路联合病灶清除术治疗胸腰椎结核的Meta分析  

Meta analysis of posterior approach andone stage combined anterior and posterior debridement in treatment of thoraco-lumbar spinal tuberculosis

作　　者：王艳波[1] 武琨[1] 宋月魏 赵晓 WANG Yan-bo;WU Kun;SONG Yue-wei;ZHAO Xiao(Department of Orthopaedics,Jiaozuo People’s Hospital,Jiaozuo,Henan 454002,China)

机构地区：[1]焦作市人民医院骨科,河南焦作454002

出　　处：《颈腰痛杂志》2023年第6期930-936,共7页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的系统性分析后路手术与一期前后路联合手术治疗胸腰椎结核(thoraco-lumbar spinal tuberculosis,TLSTB)的临床效果。方法通过计算机检索万方数据库、中国知网、维普网、PubMed、Web of Science、ScienceDirect、SpringLink、Cochrane Library等数据库,检索后路手术和一期前后路联合手术治疗TLSTB的随机对照研究(randomized controlled study,RCT)和队列研究(cohort study,CS),进行文献质量评价后,采用Revman 5.3软件进行定量合成分析。结果共纳入27篇文献,其中RCT文献7篇,CS研究20篇,共纳入患者2240例。合并Meta分析显示,后路手术和一期前后路联合手术在术后Cobb角(P=0.05)、末次随访Cobb角(P=0.47)、Cobb角矫正(P=0.32)、Cobb角矫正率(P=0.46)、Cobb角矫正丢失(P=0.44)、术后JOA评分(P=0.54)、椎骨融合时间(P=0.52)、术后ESR(P=0.88)、术后CRP(P=0.48)、术后ODI指数(P=0.94)等指标方面无统计学差异;与一期前后路联合手术相比较,后路手术可减少手术时间(P<0.001)、术中出血量(P<0.001)、住院时间(P<0.001)、术后VAS评分(P=0.01)和住院费用(P<0.001),且术后并发症发生率明显降低(P<0.001)。结论后路手术可获得与一期前后路手术一样的临床效果,且后路手术具有创伤小、出血量少、手术时间短、住院时间短、并发症少等优点。Objective To systematically analyze the clinical effect of posterior approach and one stage combined anterior and posterior debridement in the treatment of thoraco-lumbar spinal tuberculosis(TLSTB).Methods Wanfang database,CNKI,VIP,PubMed,Web of Science,ScienceDirect,SpringLink,Cochrane Library and other databases were searched by computer.The randomized controlled study(RCT)and cohort study(CS)of single posterior surgery and one stage combined anterior and posterior surgery in the treatment of TLSTB were searched.Revman5.0 was used after literature quality evaluation 3 quantitative synthetic analysis.Results A total of 27 literatures were included,including 7 RCT literatures and 20 CS studies.A total of 2240 patients were included.There was no significant difference in postoperative Cobb angle(P=0.05),Cobb angle at the last follow-up(P=0.47),Cobb angle correction(P=0.32),Cobb angle correction rate(P=0.46),Cobb angle correction loss(P=0.44),postoperative JOA score(P=0.54),vertebral fusion time(P=0.52),postoperative ESR(P=0.88),postoperative CRP(P=0.48)and postoperative ODI(P=0.94)between single posterior surgery and one stage combined anterior and posterior surgery.Compared with one stage combined anterior and posterior surgery,the operation time(P<0.001),intraoperative bleeding(P<0.001),postoperative VAS(P=0.01),hospital stay(P<0.001),hospitalization expenses(P<0.001)and postoperative complications(P<0.001)of patients with posterior surgery were significantly reduced.Conclusion The posterior approach can obtain the same clinical effect as the one stage combined anterior and posterior surgery,and the posterior approach has the advantages of less trauma,less bleeding,short operation time,short hospital stay and less complications.

关 键 词：脊柱结核 手术入路 临床疗效 META分析 

分 类 号：R529.2[医药卫生—内科学]