后路短节段与长节段椎弓根内固定治疗胸腰椎爆裂骨折Meta分析被引量：2

Posterior short segment and long segment pedicle screws internal fixation in treatment of thoracolumbar burst fracture：Meta analysis

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摘要目的系统评价后路短节段与长节段椎弓根内固定治疗胸腰椎爆裂骨折的有效性和安全性.方法通过检索PubMed,EMBASE,the Cochrane Central Register of Controlled Trials等数据库,全面纳入关于比较后路短节段与长节段椎弓根内固定治疗胸腰椎爆裂骨折的研究并进行Meta分析.结果纳入14篇研究共658例患者,其中短节段组320例,长节段组338例,进行Meta分析.结果显示短节段组与长节段组比较,术后及末次随访伤椎畸形角度,末次随访失状位指数差异无统计学意义（MD=-0.22,95%CI-2.73,2.28,P=0.86;MD=-0.28,95%CI-2.23,1.67,P=0.78;MD=0.47,95%CI-3.45,4.39,P=0.81）;术后COBB角、伤椎前缘高度、压缩率差异无统计学意义（MD=0.21,95%CI-0.65,1.06,P=0.64;MD=-0.46,95%CI-1.40,0.49,P=0.34;MD=0.47,95%CI-2.28,3.21,P=0.74）,末次随访时COBB角、伤椎前缘高度、压缩率、矫正丢失度差异具有统计学意义（MD=5.11,95%CI 2.81,7.40,P〈0.0001;MD=-11.89,95%CI-15.28,-8.50,P〈0.00001;MD=6.46,95%CI 3.85,9.07,P〈0.00001;MD=-11.89,95%CI-15.28,-8.50,P〈0.00001）;末次随访时VAS评分及ODI评分差异无统计学意义（MD=0.01,95%CI-0.15,0.17,P=0.9;MD=-0.47,95%CI-2.68,1.74,P=0.86）;两组内固定失败差异有统计学意义（RR=0.08,95%CI 0.01,0.15,P=0.02）.结论后路长节段椎弓根内固定手术治疗胸腰椎爆裂性骨折可能比短节段手术更有效,能减少COBB角,恢复伤椎前缘高度,减少伤椎前缘压缩率,降低内固定失败的风险,更有利于胸腰椎爆裂性骨折的治疗. Objective To systematically evaluate the efficacy and safety of posterior short segment and long segment pedicle screw internal fixation in the treatment of thoracolumbar burst fracture. Methods By searching the database, including PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, a comprehensive study was carried out to make a comparison between the posterior short segment and the long segment pedicle screws internal fixation in treatment of thoracolumbar burst fracture, and Meta analysis was performed. Results A total of 14 related studies and 658 patients were enrolled in the study, including 320 patients in short segment group and 338 cases in long segment group, and Meta analysis was performed. The results suggested that there was no significant difference between the short segment group and the long segment group in terms of the deformity angle of the injured vertebra measured after operation and at the last follow？up, and sagittal index at the last follow？up （ MD=-0. 22,95%CI -2. 73,2. 28,P=0. 86;MD=-0. 28,95%CI -2. 23,1. 67, P=0. 78;MD=0. 47, 95%CI -3. 45, 4. 39, P=0. 81 ） . Besides, both groups had no statistical difference in post？operative COBB angle,anterior vertebral height and compression rate of injured vertebrae （ MD=0. 21,95%CI -0. 65,1. 06,P=0. 64; MD=-0. 46,95%CI -1. 40,0. 49,P=0. 34; MD=0. 47,95%CI -2. 28, 3. 21, P= 0. 74 ） , while the differences in COBB angle, anterior vertebral height, compression rate, correction loss were statistically significant at the last follow？up （MD=5. 11,95%CI 2. 81,7. 40,P〈0. 0001;MD=-11. 89,95%CI-15. 28,-8. 50,P〈0. 00001;MD=6. 46,95%CI 3. 85,9. 07,P〈0. 00001） . There was no significant difference in VAS scores and the ODI scores between the two groups at the last follow？up （ MD =0. 01,95%CI -0. 15,0. 17,P=0. 9; MD=-0. 47,95%CI -2. 68,1. 74,P=0. 86）,while the two groups showed statistically significant difference in fixation failure （ RR = 0. 08, 95%CI 0. 01, 0. 15, P = 0. 02 ） . Conclusion Posterior long segment pedicle screw internal fixation is more effective in treating thoracolumbar burst fracture than short segment surgery. It can reduce the COBB angle,restore the anterior height of the injured vertebra,and decrease the anterior vertebral pressure.

作者黄揆韩洋涂悦李军何志江孙明林 Huang Kui Han Yang Tu Yue Li Jun He Zhijiang Sun Minglin(Logistics University of People＇s Armed Police Force, Tianjin 300309, Chin)

机构地区武警后勤学院武警黑龙江省总队七台河支队武警后勤学院附属医院脑科中心武警后勤学院附属医院脊柱科

出处《中国综合临床》 2017年第9期769-777,共9页 Clinical Medicine of China

基金国家自然科学基金资助项目（31200809）

关键词 META分析胸腰椎爆裂骨折短节段长节段椎弓根内固定 META analysis Thoracolumbar burst fracture Short segment Long segment Pedicle Internal fixation

分类号 R687.3 [医药卫生—骨科学]

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