摘要
目的系统评价经皮椎弓根螺钉内固定术(percutaneous pedicle screw fixation)与后路开放椎弓根螺钉内固定术(posterior open pedicle screw fixation)治疗胸腰段脊柱骨折的疗效,为胸腰段骨折的治疗提供更好的科学依据。方法检索并收集经皮椎弓根螺钉内固定术与后路开放手术治疗胸腰段脊柱骨折的比较性研究。计算机检索下列数据库:Pubmed(1966年至2016年3月)、Cochrane图书馆(2016年第3期)、Embase(1966年至2016年3月)。人工检索期刊(1990年至2016年3月)The Journal of Bone and Joint Surgery、Spine、European Spine Journal。2名脊柱外科专业评价员根据纳入与排除标准,独立筛选文献,使用Cochrane协作网提供的Rev Man5.3进行Meta分析。结果最终纳入5项随机对照试验(randomized controlled trail,RCT),共计318例,其中经皮椎弓根螺钉内固定术158例,后路开放椎弓根螺钉内固定术160例。Meta分析后结果显示,经皮椎弓根螺钉内固定组与后路开放椎弓根螺钉内固定组相比,手术时间短[WMD=-0.67,95%CI(-1.20,-0.14),P=0.01],出血量少[WMD=-2.83,95%CI(-4.15,-1.51),P<0.0001],术后总体疼痛视觉模拟评分(visual analogue scale,VAS)小[WMD=-2.79,95%CI(-3.80,-1.77),P<0.0001],术后3个月VAS评分小[WMD=-2.33,95%CI(-3.08,-1.58),P<0.00001],住院时间短[WMD=-1.79,95%CI(-2.48,-1.11),P<0.00001],而两者术后1周内VAS评分[WMD=-4.02,95%CI(-8.98,0.94),P=0.11]、术后手术节段Cobb’s角[WMD=-0.72,95%CI(-2.32,0.89),P=0.38]、术后手术节段Cobb’s角矫正度丢失[WMD=-0.05,95%CI(-0.40,0.31),P=0.80]、手术并发症发生率[RR=0.57,95%CI(0.19,1.67),P=0.30]、椎弓根螺钉位置异常发生率[RR=0.69,95%CI(0.20,2.37),P=0.55]、术后感染发生率[RR=0.34,95%CI(0.04,3.18),P=0.34]相比,差异均无统计学意义。结论经皮椎弓根螺钉内固定术与后路开放椎弓根螺钉内固定术相比,手术时间短,出血量少,住院时间短,术后3个月时VAS评分较低,但是两者术后1周内VAS评分、术后Cobb’s角大小及术后矫正度丢失、手术并发症的发生率相比,差异均无统计学意义。
Objective To systematically review the clinical results of percutaneous pedicle screw fixation and posterior open pedicle screw fixation for thoracolumbar fractures, and to collect better scientific evidence in the treatment of thoracolumbar fractures. Methods The randomized controlled trials（ RCTs） were performed to analyze the clinical results of percutaneous pedicle screw fixation and posterior open pedicle screw fixation in the treatment of thoracolumbar fractures. The computer retrieval of Pubmed（ from 1966 to March 2016）, Cochrane Central Register of Controlled Trails（ CENTRAL）（ No.3 2016） and Embase（ from 1966 to March 2016） was performed. The related journals（ from 1990 to March 2016） such as the Journal of Bone and Joint Surgery, Spine and European Spine Journal, were manually searched. According to the inclusion and exclusion criteria, the literature was selected independently by 2 professional spinal surgeons. The meta-analysis of all the data was carried out using the Cochrane Collaboration＇s Rev Man5.3 software. Results Through systematic retrieval and screening, 5 RCTs were identified, with 318 cases in all. There were 158 cases of percutaneous pedicle screw fixation and 160 cases of posterior open pedicle screw fixation. The meta-analysis results showed that shorter surgery time [ WMD =-0.67, 95% CI（-1.20,-0.14）, P = 0.01 ], less intraoperative blood loss [ WMD =-2.83, 95% CI（-4.15,-1.51）, P〈0.0001 ], lower overall postoperative VAS score [ WMD =-2.79, 95% CI（-3.80,-1.77）, P〈0.0001 ], lower VAS score at 3 months after the operation [ WMD =-2.33, 95% CI（-3.08,-1.58）, P〈0.00001 ] and shorter hospital length of stay [ WMD =-1.79, 95% CI（-2.48,-1.11）, P〈0.00001 ] in the percutaneous pedicle screw fixation group, compared with the posterior open pedicle screw fixation group. No statistically significant differences were found between the 2 groups with regard to VAS score at 1 week after the operation [ WMD =-4.02, 95% CI（-8.98, 0.94）, P = 0.11 ], postoperative Cobb＇s angle [ WMD =-0.72, 95% CI（-2.32, 0.89）, P = 0.38 ], postoperative Cobb＇s angle correction loss [ WMD =-0.05, 95% CI（-0.40, 0.31）, P = 0.80 ], complication rate [ RR = 0.57, 95% CI（ 0.19, 1.67）, P = 0.30 ], pedicle screw misplacement rate [ RR = 0.69, 95% CI（ 0.20, 2.37）, P = 0.55 ] and postoperative infection rate [ RR = 0.34, 95% CI（ 0.04, 3.18）, P = 0.34 ]. Conclusions Shorter surgery time, less intraoperative blood loss, shorter hospital length of stay and lower VAS score at 3 months after the operation are noticed in percutaneous pedicle screw fixation when compared with posterior open pedicle screw fixation. However, no statistically significant differences are found between the 2 groups with regard to VAS score at 1 week after the operation, postoperative Cobb＇s angle, postoperative Cobb＇s angle correction loss and complication rate.
作者
孙祥耀
张希诺
海涌
SUN Xiang-yao ZHANG Xi-nuo HAI Yong(Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, PRC)
出处
《中国骨与关节杂志》
CAS
2016年第11期828-834,共7页
Chinese Journal of Bone and Joint
关键词
脊柱骨折
胸椎
腰椎
最小侵入性外科手术
META分析
Spinal fractures
Thoracic vertebrae
Lumbar vertebrae
Minimally invasive surgical procedures
Meta-analysis
