摘要
目的比较椎弓根螺钉联合伤椎骨水泥强化(PSV)与椎弓根螺钉联合伤椎置钉(PSIS)治疗骨质疏松性胸腰椎骨折(OTLF)的疗效。方法通过检索PubMed、Cochrane Library、Web of Science、中国知网、维普数据库及万方数据库所有关于对比PSV与PSIS治疗OTLF的随机对照试验(RCT)和病例对照试验(CCT)文献。由2名研究者按照纳入与排除标准独立进行文献筛选、资料提取和质量评价后,采用Revman 5.4软件行Meta分析。按照治疗术式不同,将研究对象分为PSV组和PSIS组,比较两组手术时间、术中出血量、术后切口感染率、术后早中远期视觉模拟评分(VAS)、术后早中期Oswestry功能障碍指数(ODI)、住院时间、术后早中远期Cobb角、术后早中远期骨折椎体前缘高度比(VBH)及内固定物失效率。结果共纳入12篇文献,研究对象共计870例,其中PSV组433例,PSIS组437例。Meta分析结果显示,两组手术时间(WMD=7.07,95%CI⁃4.00,18.13,P>0.05)、术中出血量(WMD=0.62,95%CI⁃7.19,8.43,P>0.05)、术后切口感染率(OR=0.65,95%CI 0.10,4.08,P>0.05)、术后早期Cobb角(WMD=-0.19,95%CI⁃0.43,0.05,P>0.05)、术后早期VBH(WMD=0.91,95%CI⁃1.30,3.13,P>0.05)差异无统计学意义。两组术后早期VAS(WMD=-0.59,95%CI⁃1.02,-0.15,P<0.05)、术后中期VAS(WMD=-0.41,95%CI⁃0.65,-0.16,P<0.05)、术后远期VAS(WMD=-0.51,95%CI⁃0.59,-0.43,P<0.05)、术后早期ODI(WMD=-6.26,95%CI⁃9.65,-2.87,P<0.05)、术后中期ODI(WMD=-2.44,95%CI⁃3.43,-1.45,P<0.05)、住院时间(WMD=-2.65,95%CI⁃4.61,-0.68,P<0.05)、术后中期Cobb角(WMD=-1.40,95%CI⁃2.41,-0.39,P<0.05)、术后远期Cobb角(WMD=-1.06,95%CI-1.59,-0.52,P<0.05)、术后中期VBH(WMD=3.06,95%CI 1.31,4.81,P<0.05)、术后远期VBH(WMD=4.11,95%CI 2.44,5.77,P<0.05)及内固定物失效率(OR=0.26,95%CI 0.11,0.59,P<0.05)等方面差异有统计学意义。结论PSV较PSIS治疗OTLF,虽不能缩短手术时间、减少术中出血量和切口感染率,但可显著缓解患者疼痛、改善功能、减
Objective To evaluate the efficacy between pedicle screws combined with vertebroplasty(PSV)and pedicle screws combined with intermediate screws(PSIS)for the treatment of osteoporotic thoracolumbar fracture(OTLF).Methods PubMed,Cochrane Library,Web of Science,CNKI,VIP and Wanfang database were searched for all randomized controlled trial(RCT)or case⁃control trial(CCT)studies that comparing PSV and PSIS for the treatment of OTLF.Two reviewers independently screened the studies in the light of the inclusion and exclusion criteria,extracted data and evaluated the quality of the included studies.The Meta⁃analysis was performed using the RevMan 5.4 software.The subjects were divided into PSV group and PSIS group according to different treatment methods.Operation time,intraoperative blood loss,postoperative incision infection rate,postoperative short⁃,mid⁃and long⁃term visual analogue scale(VAS)score,postoperative short⁃and mid⁃term Oswestry disability index(ODI),hospitalization time,postoperative short⁃,mid⁃and long⁃term Cobb angle,postoperative short⁃,mid⁃and long⁃term anterior vertebral height ratio(VBH)and implant failure rate were compared between the two groups.Results A total of 12 studies were enrolled for review,involving 870 subjects(433 in PSV group and 437 in PSIS group).The results showed insignificant difference between the two groups in operation time(WMD=7.07,95%CI⁃4.00,18.13,P>0.05),intraoperative blood loss(WMD=0.62,95%CI⁃7.19,8.43,P>0.05),postoperative incision infection rate(OR=0.65,95%CI 0.10,4.08,P>0.05),postoperative short-term Cobb angle(WMD=-0.19,95%CI⁃0.43,0.05,P>0.05)and postoperative short⁃term VBH(WMD=0.91,95%CI⁃1.30,3.13,P>0.05).However,there was significant difference between the two groups in postoperative short⁃term VAS score(WMD=-0.59,95%CI-1.02,-0.15,P<0.05),mid⁃term VAS score(WMD=⁃0.41,95%CI⁃0.65,-0.16,P<0.05),long⁃term VAS score(WMD=-0.51,95%CI⁃0.59,-0.43,P<0.05),postoperative short⁃term ODI(WMD=-6.26,95%CI-9.65,-2.87,P<0.05),postoper
作者
冯铭哲
都金鹏
王江
汤志毅
苗云峰
张迦琅
李帅
屈泽超
贺宝荣
Feng Mingzhe;Du Jinpeng;Wang Jiang;Tang Zhiyi;Miao Yunfeng;Zhang Jialang;Li Shuai;Qu Zechao;He Baorong(Yan′an University Medical College,Yan′an 716099,China;Department of Spine Surgery,Honghui Hospital Affiliated to Xi′an Jiaotong University,Xi′an 710054,China;Shaanxi University of Traditional Chinese Medicine,Xianyang 712046,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2023年第2期127-137,共11页
Chinese Journal of Trauma
基金
陕西省卫生健康科研基金项目(2022A004)
陕西省中医药管理局项目(2021⁃02⁃22⁃016)
西安市创新能力强基计划(21YXYJ0024)。
