后路短节段固定治疗胸腰椎爆裂性骨折同时行植骨融合的系统评价

目的系统评价后路短节段固定治疗胸腰椎爆裂性骨折同期行植骨融合的术后效果及不良反应。方法计算机检索Cochrane图书馆、MEDLINE（1966—2009年）、EMBASE（1980—2009年）、中国生物医学文献数据库（CBMdisc）等数据库。手工检索6种主要中文骨科杂志。收集比较后路短节段固定同时行植骨融合与非植骨融合治疗胸腰椎爆裂性骨折的临床随机对照试验进行Meta分析，并评价纳入研究的方法学质量。统计软件采用Cochrane协作网提供的RevMan5．0。结果共纳入随机对照试验4篇，221例患者，按植骨融合手术方式不同分成3个亚组，Meta分析结果表明，后路短节段固定治疗胸腰椎爆裂性骨折同期行椎体后外侧或经椎弓根椎体内植骨融合与非融合组比较，二者在防止术后后凸角丢失、椎体高度丢失及内固定物失败上差异无统计学意义，而同时行椎体后外侧加椎体内植骨融合与非融合组比较，在防止术后后凸角丢失、椎体高度丢失方面差异有统计学意义（P〈0．00001和P〈0．0001）。植骨融合组与非植骨融合组在改善术后神经功能方面差异无统计学意义。行植骨融合组在手术时间和术中失血量方面普遍高于非融合组，且术后伴随相当比例的供骨区疼痛。结论单纯的椎体后外侧植骨融合或椎体内植骨融合对后路短节段固定治疗胸腰椎爆裂性骨折术后效果并不优于非植骨融合组，同时行椎体内加椎体后外侧植骨融合对严重的胸腰椎爆裂性骨折患者在行后路短节段内固定治疗时可能是需要的。尚需更多设计严格的大样本随机对照研究来增加证据的强度。

Bone Grafting Fusion for Surgically Treated Thoracolumbar Burst Fractures with Posterior Short-Segment Fixation:A Systemic Analysis

Objective To determine the efficacy and complication rate of posterior short-segment fixation with or without bone grafting fusion in the treatment of thoracolumbar burst fractures. Methods We searched the Cochrane Library（including CENTRAL）, MEDLINE（1966 to 2009）, EMBASE（1980 to 2009）, PubMed（1966 to 2009）, CBMdisc （1979 to May 2009）and so on. We also hand searched some main Chinese orthopedic journals. Data were extracted and evaluated by two reviewers independently. Randomized controlled trials comparing bone grafting fusion with nonfusion for surgically treated thoracolumbar burst fractures with posterior short-segment fixation were included and the quality of these trials was critically assessed. Data analyses were done using the Cochrane Collaboration＇s RevMan 5.0. Results Four randomized controlled trials involving 221 patients were included. These trials were divided into three subgroups in accordance with the surgical procedure. The meta analysis showed that when posterolateral bone grafting or transpadicular intracorpareal fusion vesus nonfusion for the treatment of thoracolumbar burst fractures with posterior short-segment fixation, two groups were not significantly different in the prevention of postoperative kyphosis angle and vertebral body height loss and implant loosening and failure. While combining posterolateral bone grafting with transpadicular intracorporeal fusion versus nonfusion, two groups had statistical significance （P〈0.000 01 and P〈0.000 1 ） in the prevention of postoperative kyphosis angle and vertebral body height loss. Bone grafting fusion group did not improve postoperative neurological function better when compared with nonfusion group. Fusion group had generally more operative time and perioperative blood loss than the nonfusion group. The rate of donor pain was also considerable for bone grafting fusion group. Conclusions The fixation effect of simple posterolateral fusion or transpadecular intracorporeal grafting are not superior to nonfusion group for the treatment of thoracalumbar burst fractures with posterior short-segment fixation. Combining posterolateral grafting fusion with transpadecular intracorpareal grafting fusion may be needed for seriors thoracolumbar burst fractures. Further well-designed and large-scale randomized controlled trials are required to determine the effects of bone grafting fusion on these outcomes.