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

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 Manager5.3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1360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=0.0003],术中出血量多MD=225.21,95%CI(171.07,279.35),P0.00001],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),P0.00001],术后运动评分高MD=13.15,95%CI(7.02,19.29),P0.0001],伤椎高度高MD=1.36,95%CI(0.79,1.92),P0.00001],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。

Anterior versus posterior decompression for the treatment of thoracolumbar fractures with spinal cord injury:a Meta-analysis

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 timeMD=80.09,95% CI(36.83,123.34),P=0.000 3],more intraoperative blood lossMD=225.21,95%CI(171.07,279.35),P<0.000 01],longer hospitalization timeMD=2.31,95% CI(0.32,4.31),P=0.02]. And the postoperative tactile scoreMD=13.39,95% CI(9.86,16.92),P<0.000 01],postoperative motor scoreMD=13.15,95% CI(7.02,19.29),P<0.000 1],vertebral heightMD=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 treatmentOR=1.14,95% CI(0.56,2.31),P=0.72],neurological recoveryOR=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.