摘要
目的应用Meta分析评价胸腰椎爆裂骨折在后路手术对椎管的间接减搓与直接减压两种方式的临床疗效，为临床治疗决策提供依据。方法计算机检索PubMed（1990年1月至2012年5月）、Webofknowledge（1990年1月至2012年5月）、中国期刊全文数据库（1990年1月至2012年5月）、维挎数据（库1994年垒2011年5月）和万方数据库（1990年1月至2012年5月），获得有关后路问接减压内固定术和后路直接减压内固定术治疗胸腰椎爆裂骨折的临床埘照研究，对人选文献进行质繁评价，选择术中出血量、手术时间、术后引流量、术中和术后并发症的发生情况、伤椎前、后缘高度百分比及cobb角作为Meta分析的评价指标，采用RevMan5．1进行分析。结果共纳入7项研究479例忠并，全部为，中文文献，均为随机对照试验，其中间接减压组249例，直接减压组230例。Meta分析结果显示：与直接减压相比，间接减压治疗胸腰椎爆裂骨折的手术时间短[MD=-57．31，95％CI（-71．99，-42．63），P〈0．05]、术中出血量少[MD=-256．92，95％CI（-293．58，-220．25），P〈0．05l、术后引流量少[MD=-110．30，95％CI（-186．60，-33．99），P=0．005]、并发症的发生率少[OR=0．16，95％CI（0．07，0．36），P〈0．05]，差异均有统计学意义。而两种治疗方式在伤椎前、后缘高度百分比、cobb角矫正方面比较差异均无统汁学意义（P〉0．05）。结论与后路直接减压比较，间接减压在愈后效果相似的情况下，具有手术时间短、术中出血量少、术后引流量少，术后并发症少、避免二次损伤等优势。
Objective To systematically evaluate the clinical efficacy of indirect and open de- compressions in the treatment of thoraeolumbar burst fractures through the posterior approach using Meta-analysis. Methods We searched PubMed （from January 1990 to May 2012）, Web of Knowledge （from January 1990 to May 2012）, Chinese Journal Full-text Database （from January 1990 to 2012 in May）, CQVIP （from January 1990 to May 2012）, WANFANG Data （from January 1990 to May 2012） fi）r eontrolled elinical studies comparing posterior indirect deco,npression plus internal fixation and posterior open decom- pression plus internal fixation for thoraeolumbar burst fractures. The quality of selected researches was eval- uated using Revnmn 5. I software. Meta-analysis was adopted to evaluate the 2 decompressions in terms of intraoperative bleeding, operation time, postoperative drainage, intraoperative and postoperative complica- tions, anterior and posterior height ratio of the injured vertebra, and cobb angle. Results A total of 7 Chinese randon, ized clinical trials （RCTs） with 479 patients were included in the present analysis. There were 249 patients in the indirect decompression group and 230 in the open decompression group. Compared with open decompression, indirect decompression led to significantly less operation time [ MD = -57.31, 95% CI （ -71.99, -42.63）, P 〈 0.05], significantly less intraoperative bleeding ]MD= -256.92, 95% CI （ - 293.58, - 220.25）, P 〈 0.05], significantly less postoperative drainage [ MD = - 110. 30, 95% CI（ - 186.60, - 33.99）, P = 0. 005], and significantly fewer complications [OR = 0. 16, 95% CI （0.07, 0. 36）, P 〈 0. 05] . There were no significant differences between the 2 decompressions in anterior and posterior height ratio of the injured vertebra or correction of the cobb angle （ P 〉 0. 05）. Conclusions Compared with open posterior decompression, indirect posterior decompression may result in similar clinical prognosis, but shorter operation time, less blood loss, less postoperative drainage, and less postoperative complications. It also has an advantage of avoiding secondary damage caused by surgery.
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2012年第12期1065-1071,共7页
Chinese Journal of Orthopaedic Trauma
基金
黑龙江省科技攻关项目（GC07C34802）
关键词
胸椎
腰椎
骨折
骨折固定术
减压术
外科
Thoracic vertebrae
Lumber vertebrae
Fractures
Fracture fixation, internal
Decompression, surgical
