| 前路与后路减压治疗胸腰段骨折合并脊髓损伤疗效的Meta分析 |
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Received:June 19, 2018
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| 作者 | Author | 单位 | Unit | E-Mail |
| 任恩惠 |
REN En-hui |
兰州大学第二医院骨科, 甘肃 兰州 730000
甘肃省骨关节疾病研究重点实验室, 甘肃 兰州 730000 |
Department of Orthopaedics, the Second Hospital of Lanzhou University, Lanzhou 730000, Gansu, China |
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| 邓亚军 |
DENG Ya-jun |
兰州大学第二医院骨科, 甘肃 兰州 730000
甘肃省骨关节疾病研究重点实验室, 甘肃 兰州 730000 |
Department of Orthopaedics, the Second Hospital of Lanzhou University, Lanzhou 730000, Gansu, China |
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| 解琪琪 |
XIE Qi-qi |
兰州大学第二医院骨科, 甘肃 兰州 730000
甘肃省骨关节疾病研究重点实验室, 甘肃 兰州 730000 |
Department of Orthopaedics, the Second Hospital of Lanzhou University, Lanzhou 730000, Gansu, China |
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| 李文洲 |
LI Wen-zhou |
兰州大学第二医院骨科, 甘肃 兰州 730000
甘肃省骨关节疾病研究重点实验室, 甘肃 兰州 730000 |
Department of Orthopaedics, the Second Hospital of Lanzhou University, Lanzhou 730000, Gansu, China |
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| 史卫东 |
SHI Wei-dong |
兰州大学第二医院骨科, 甘肃 兰州 730000
甘肃省骨关节疾病研究重点实验室, 甘肃 兰州 730000 |
Department of Orthopaedics, the Second Hospital of Lanzhou University, Lanzhou 730000, Gansu, China |
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| 马靖琳 |
MA Jing-lin |
甘肃省骨关节疾病研究重点实验室, 甘肃 兰州 730000 |
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| 汪静 |
WANG Jing |
兰州大学第二医院骨科, 甘肃 兰州 730000
甘肃省骨关节疾病研究重点实验室, 甘肃 兰州 730000 |
Department of Orthopaedics, the Second Hospital of Lanzhou University, Lanzhou 730000, Gansu, China |
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| 康学文 |
KANG Xue-wen |
兰州大学第二医院骨科, 甘肃 兰州 730000 |
Department of Orthopaedics, the Second Hospital of Lanzhou University, Lanzhou 730000, Gansu, China |
13919026469@163.com |
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| 期刊信息：《中国骨伤》2019年32卷，第3期，第269-277页 |
| DOI：10.3969/j.issn.1003-0034.2019.03.015 |
| 基金项目:国家自然科学基金（编号：81371230） |
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目的：系统评价前路减压（anterior decompression）与后路减压（posterior decompression）治疗胸腰段骨折合并脊髓损伤的疗效与安全性，为胸腰段骨折合并脊髓损伤的疗效提供更好的科学依据。
方法：检索并收集前路减压与后路减压治疗胸腰段骨折合并脊髓损伤的比较性研究。通过计算机检索下列数据库：Pubmed、Embase、Cochrane图书馆、CNKI、CBM、万方医学网。人工检索期刊Spine、European Spine Journal、The Journal of Bone and Joint Surgery。2名脊柱外科专业人员按照既定的纳入与排除标准，独立筛选文献，并对各纳入的研究进行质量评价。使用Review Manager 5.3软件对数据进行Meta分析，观察指标包括手术时间、术中出血量、术后触觉评分、术后运动评分、术后伤椎高度、住院时间、神经功能恢复、治疗有效率及术后并发症。
结果：最终纳入15项随机对照试验（randomized controlled trail，RCT），共1 360例患者，其中前路减压术680例，后路减压术680例。Meta分析结果示，与后路减压组相比，前路减压组手术时间长[MD=80.09，95% CI（36.83，123.34），P=0.000 3]，术中出血量多[MD=225.21，95% CI（171.07，279.35），P<0.000 01]，住院时间长[MD=2.31，95% CI（0.32，4.31），P=0.02]，术后触觉评分高[MD=13.39，95% CI（9.86，16.92），P<0.000 01]，术后运动评分高[MD=13.15，95% CI（7.02，19.29），P<0.000 1]，伤椎高度高[MD=1.36，95% CI（0.79，1.92），P<0.000 01]，而两者在治疗有效率[OR=1.14，95% CI（0.56，2.31），P=0.72]、神经功能恢复[OR=0.87，95% CI（0.57，1.33），P=0.52]方面，差异均无统计学意义。
结论：前路减压与后路减压相比，手术时间长，术中出血量多，住院时间长，术后触觉评分高，术后运动评分高，伤椎高度高，但是两者在治疗有效率、神经功能恢复方面差异无统计学意义。 |
| [关键词]:胸腰段骨折 脊髓损伤 前路手术 后路手术 Meta分析 |
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| Anterior versus posterior decompression for the treatment of thoracolumbar fractures with spinal cord injury:a Meta-analysis |
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Abstract:
Objective:To systematically evaluate the efficacy and safety of anterior decompression and posterior decompression in the treatment of thoracolumbar fractures with spinal cord injury,so as to provide a good scientific basis for more effective treatment of thoracolumbar fractures with spinal cord injury.
MethodsA clinical data about comparative study of anterior decompression and posterior decompression in the treatment of thoracolumbar fractures with spinal cord injury was searched and collected. The databases of Pubmed,Embase,Cochrane Library,CNKI,CBM,Wanfang Medical Network were searched by computer. Artificially collected journals included Spine,European Spine Journal,The Journal of Bone and Joint Surgery. Two spine surgeons independently screened the literature according to established inclusion and exclusion criteria and assessed the quality of the included studies. Meta-analysis was performed on the data using Review Manager 5.3 software,the indicators included operative time,intraoperative blood loss,postoperative tactile score,postoperative motor score,postoperative vertebral height,hospitalization time,neurological function recovery,efficiency of treatment,postoperative complications.
ResultsFifteen randomized controlled trials (RCTs) were enrolled in a total of 1 360 patients,including 680 anterior decompression and 680 posterior decompression. The results of Meta-analysis showed that the anterior decompression group had longer operation time[MD=80.09,95% CI(36.83,123.34),P=0.000 3],more intraoperative blood loss[MD=225.21,95%CI(171.07,279.35),P<0.000 01],longer hospitalization time[MD=2.31,95% CI(0.32,4.31),P=0.02]. And the postoperative tactile score[MD=13.39,95% CI(9.86,16.92),P<0.000 01],postoperative motor score[MD=13.15,95% CI(7.02,19.29),P<0.000 1],vertebral height[MD=1.36,95% CI(0.79,1.92),P<0.000 01] in anterior decompression were higher than that in posterior decompression. There was no statistically significant differences in the efficacy of treatment[OR=1.14,95% CI(0.56,2.31),P=0.72],neurological recovery[OR=0.87,95% CI(0.57,1.33),P=0.52] between two groups.
ConclusionCompared with posterior decompression,the anterior decompression has the advantages of longer operating time,more intraoperative blood loss,longer hospitalization time,higher postoperative tactile score,higher postoperative motor score,and higher injury vertebral height,But there was no significant difference in the treatment efficiency and nerve function recovery between two groups. |
| KEYWORDS:Thoracolumbar fractures Spinal cord injury Anterior approach surgery Posterior approach surgery 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: | 任恩惠,邓亚军,解琪琪,李文洲,史卫东,马靖琳,汪静,康学文.前路与后路减压治疗胸腰段骨折合并脊髓损伤疗效的Meta分析[J].中国骨伤,2019,32(3):269~277 |
| 英文格式: | REN En-hui,DENG Ya-jun,XIE Qi-qi,LI Wen-zhou,SHI Wei-dong,MA Jing-lin,WANG Jing,KANG Xue-wen.Anterior versus posterior decompression for the treatment of thoracolumbar fractures with spinal cord injury:a Meta-analysis[J].zhongguo gu shang / China J Orthop Trauma ,2019,32(3):269~277 |
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