| 彻底与非彻底病灶清除术治疗脊柱结核疗效的Meta分析 |
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Received:January 21, 2018
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| 作者 | Author | 单位 | Unit | E-Mail |
| 农家隆 |
NONG Jia-long |
百色市人民医院骨科, 广西 百色 533000 |
Department of Orthopaedics, People'Hospital of Baise, Baise 533000, Guangxi, China |
fsnjl1508@163.com |
| 隆振学 |
LONG Zhen-xue |
百色市人民医院骨科, 广西 百色 533000 |
Department of Orthopaedics, People'Hospital of Baise, Baise 533000, Guangxi, China |
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| 陆春先 |
LU Chun-xian |
百色市人民医院骨科, 广西 百色 533000 |
Department of Orthopaedics, People'Hospital of Baise, Baise 533000, Guangxi, China |
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| 期刊信息：《中国骨伤》2018年31卷，第7期，第642-650页 |
| DOI：10.3969/j.issn.1003-0034.2018.07.011 |
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目的:通过Meta分析比较病灶彻底清除术与病灶非彻底清除术对脊柱结核的临床疗效。
方法：系统检索Medline、EMBASE、Cochrane Library、Web of Science、CBM、CNKI和万方7个数据库，查找所有比较彻底与非彻底病灶清除术治疗脊柱结核的随机对照试验与非随机对照试验（RCT or non-RCT），检索时间均为建库至2017年7月17日。按纳入排除标准由两名研究人员独立筛选文献、提取数据、评价纳入研究的偏倚风险。采用Revman 5.3软件进行Meta分析，并采用GRADE系统对证据质量进行分级。对两种清除术的复发率、不良反应发生率、治愈时间、化疗时间、脊柱畸形矫正角度、椎间界面融合时间、术后ESR及CRP进行比较。
结果：共纳入9篇文献，5篇RCT，4篇NON-RCT，共1 302例患者。与病灶非彻底清除术比较，病灶彻底清除术有更低的复发率[OR=0.14，95% CI （0.08，0.22），P<0.000 01]和不良反应发生率[OR=0.18，95% CI （0.12，0.27），P<0.000 01]，治愈时间[MD=-4.80，95% CI （-5.14，-4.45），P<0.000 01]与化疗时间[MD=-5.25，95% CI （-5.64，-4.86），P<0.000 01]更短，术后脊柱畸形能矫正的角度更大[MD=4.88，95% CI （3.55，6.27），P<0.000 01]，术后的ESR[MD=-8.74，95% CI （-11.99，-5.49），P<0.000 01]及CRP[MD=-4.75，95% CI （-8.61~-0.88），P=0.02]更低。但是两组在椎间界面骨性融合时间方面差异无统计学意义[MD=-0.19，95% CI （-0.50，0.12），P=0.23]。
结论：病灶彻底清除术治疗脊柱结核与非彻底清除术相比，术后复发率显著降低，不良反应发生率少，且能明显缩短化疗时间及治愈时间，患者术后康复得更快。选择哪种手术方式主要根据患者的适应证，但是在相同适应证的情况下病灶彻底清除术应该被推荐。 |
| [关键词]:脊柱 结核 病灶清除术 Meta分析 |
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| Comparison of clinical efficacy of complete and incomplete radical debridement for spinal tuberculosis: a Meta-analysis |
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Abstract:
Objective: To compare clinical efficacy of complete and incomplete radical debridement for spinal tuberculosis by Meta-analysis.
Methods: The literatures of RCT or non-RCT with complete and incomplete radical debridement for spinal tuberculosis from Medline,EMBASE,Cochrane Library,Web of Science,CBM,CNKI and Wanfang were searched from the time of creating database to July,2017. Two independent reviewers identified eligible studies,extracted data and evaluated risk of bias of included studies. Meta analysis were performed by Revman 5.3 and GRADE system were used to grade evidence. Recurrence rate,adverse effects,healing time,chemotherapy duration,spinal deformity by correction angle,bone fusion time in interface of intervertebral,erythrocyte sedimentation rate and C-reaction protein were compared between two groups.
Results: Totally 9 literatures were chosen,including 5 RCT and 4 non-RCT with 1 302 patients. Compared with incomplete radical debridement,complete radical debridement had lower recurrence rate[OR=0.14,95% CI(0.08,0.22),P<0.000 01],lower rate of adverse effects[OR=0.18,95% CI(0.12,0.27),P<0.000 01],shorter healing time[MD=-4.80,95% CI(-5.14,-4.45),P<0.000 01]and chemotherapy duration[MD=-5.25,95% CI(-5.64,-4.86),P<0.000 01],larger spinal deformity by correction angle[MD=4.88,95% CI(3.55,6.27),P<0.000 01],smaller erythrocyte sedimentation rate[MD=-8.74,95% CI(-11.99,-5.49),P<0.000 01] and C-reaction protein[MD=-4.75,95% CI(-8.61,-0.88),P=0.02]. However,there was no difference on bone fusion time in interface of intervertebral between two groups[MD=-0.19,95% CI(-0.50,0.12),P=0.23].
Conclusion: Compared with incomplete radical debridement,complete radical debridement has advantages of lower incidence of recurrence,lower rate of adverse reaction,shorten healing time and chemotherapy time,recovered faster. Techniques are selected according to indication of patients individual,complete radical debridement is recommended at the same indications. |
| KEYWORDS:Spine Tuberculosis Lumpectomy Meta-analysis |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 农家隆,隆振学,陆春先.彻底与非彻底病灶清除术治疗脊柱结核疗效的Meta分析[J].中国骨伤,2018,31(7):642~650 |
| 英文格式: | NONG Jia-long,LONG Zhen-xue,LU Chun-xian.Comparison of clinical efficacy of complete and incomplete radical debridement for spinal tuberculosis: a Meta-analysis[J].zhongguo gu shang / China J Orthop Trauma ,2018,31(7):642~650 |
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