摘要
目的:对单节段与短节段椎弓根钉棒固定手术治疗单节段胸腰段椎体爆裂性骨折的疗效进行Meta分析。方法:计算机检索Pubmed、Embase、Web of Science、Cochrane Library、中国知网全文数据库等数据库,检索的主题词为“单节段(mono-segment pedicle instrumentation,MSPI或monosegmental pedicle instrumentation)”及“爆裂性骨折(burst fracture)”,检索自建库起至2018年10月30日时的对照研究文献,语言限定为英文或中文。纳入关于单节段与短节段椎弓根钉棒固定手术治疗单节段胸腰段椎体爆裂性骨折的相关对照研究,患者年龄>18岁,随访时间≥1年。对纳入文献进行质量评价,回顾性队列研究使用纽卡斯尔-渥太华量表(NOS),随机对照研究采用物理治疗证据数据库(Physiotherapy Evidence Database,PEDro)量表。利用Stata 12.0统计学软件进行数据分析,根据组间异质性以加权均数差(WMD)合并效应量,并计算其95%置信区间(95%CI),异质性较大者进行敏感性分析和亚组分析辨别其异质性来源。评价指标包括手术时间、术中出血量,术前、术后及末次随访时的视觉模拟评分(VAS)、椎体后凸角和椎体压缩率。结果:经过筛选共纳入6篇文献,其中2篇为随机对照研究,4篇为回顾性队列研究,共390例患者,单节段固定组190例,短节段固定组200例。质量评价提示纳入文献均属于高质量研究,其中4篇回顾性队列研究NOS评分为5~9分、2篇随机对照研究PEDro评分均为8分。单节段固定组的手术时间显著少于短节段固定组(WMD=-23.19,95%CI:-44.63,-1.75,P=0.034),术中出血量无显著性差异(P=0.10)。术前的椎体后凸角、椎体压缩率、VAS评分两组比较无显著性差异(P>0.05);术后1周和末次随访时的椎体压缩率两组间无显著性差异(P>0.05);椎体后凸角(WMD=0.67,95%CI:-0.48,1.83)和VAS评分(WMD=-0.39,95%CI:-0.60,-0.18)在术后1周时单节段固定组均优于短节段固定组(P=0.001,P<0.0001),但�
Objectives: To compare the clinical effect between mono-segment pedicle instrumentation(MSPI) and short-segment pedicle instrumentation(SSPI) in the treatment of one-level thoracolumbar burst fracture. Methods: By searching PubMed, Embase, Web of Science, Cochrane Library and China National Knowlage Infrastructure(CNKI) etc, the studies of MSPI versus SSPI for treatment of thoracolumbar burst fracture were collected. The key words were "mono-segment pedicle instrumentation","MSPI" or "monosegmental pedicle instrumentation" and "burst fracture". Studies from the establishment of database to October 30, 2018 were retrieved, with a language restriction of Chinese or English. Comparative studies about the treatment of thoracolumbar burst fractures with mono-segment and short-segment internal fixation were included. The patients were older than 18 years old with more than one year follow-up. The risk of bias of the included studies was evaluated, Newcastle-Ottawa Scale(NOS) for retrospective cohort studies and Physiotherapy Evidence Database(PEDro) for randomized controlled studies were used. All data were analyzed by Stata 12.0 software. Weighted mean differnce(WMD) and its 95% confidence interval(95%CI) were calculated according to the heterogeneity between groups. Sensitivity analysis and subgroup analysis were performed to identify the heterogeneity sources. The outcomes included surgery related indexes(operation time, blood loss);visual analogue score(VAS), vertebral kyphosis angle and vertebral compression ratio at preoperation, postoperation and the end of follow-up. Results: Two randomized controlled trials and four cohort studies including 390 patients were included in the Meta analysis(190 patients for MSPI and 200 patients for SSPI). Quality evaluation indicated that all the included studies were high quality cohort studies(the NOS of 4 retrospective cohort studies ranged from 5 to 9, and the PEDro scores of 2 randomized controlled studies were 8). The operation time (WMD=-23.19, 95%CI:-44.63,-1.75) of the
作者
邵拓
胡宇航
张轩硕
谷佳傲
沈洪涛
于占革
SHAO Tuo;HU Yuhang;ZHANG Xuanshuo(Department of Spinal Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China)
出处
《中国脊柱脊髓杂志》
CAS
CSCD
北大核心
2019年第4期310-318,共9页
Chinese Journal of Spine and Spinal Cord
关键词
脊柱骨折
胸腰段
爆裂性
内固定
单节段
短节段
META分析
Spinal fracture
Thoracolumbar
Burst
Pedicle instrumentation
Mono-segment
Short-segment
Meta-analysis
