文献类型：期刊文献

中文题名：微创经皮与传统开放椎弓根螺钉固定治疗胸腰椎骨折的Meta分析

英文题名：Comparison of minimally invasive percutaneous and traditional open pedicle screw fixation in the treatment of thoracolumbar fractures: a systematic review and Meta-analysis

作者：薛文[1];管晓鹂[2];刘姝娆[3];康忠仁[4];王增平[3];周慧茹[5];刘林[1];钱耀文[1]

第一作者：薛文

机构：[1]甘肃省人民医院骨2科;[2]兰州大学第二医院骨2科;[3]甘肃中医药大学研究生院;[4]甘肃会宁县人民医院骨科;[5]兰州军区总医院骨科

第一机构：甘肃省人民医院骨2科

年份：2015

卷号：9

期号：23

起止页码：115

中文期刊名：中华临床医师杂志：电子版

语种：中文

中文关键词：骨科;胸腰椎骨折;微创手术;CONSORT声明;报告质量评价

外文关键词：Orthopedic surgery;;Thoracolumbar fracture;;Minimally invasive surgery;;CONSORT statement;;Report quality evaluation

摘要：目的对微创经皮与传统开放椎弓根螺钉固定治疗胸腰椎骨折的疗效和术后并发症进行质量评价和Meta分析。方法计算机检索Pub Med、The Cochrane Library、CBM、CNKI、VIP及Wan Fang Date数据库,全面收集微创经皮与传统开放椎弓根螺钉固定治疗胸腰椎骨折随机对照试验(RCT),检索时限均为建库至2015年,并追溯纳入研究的参考文献。由四位研究者按照纳入与排除标准独立筛选文献、提取资料和评价质量后,采用Rev Man 5.2软件进行Meta分析。应用CONSORT声明和一些外科临床评价指标对纳入随机对照试验文献的报告质量进行综合评价。结果共纳入28个研究(25个随机对照试验/半随机对照试验和3个回顾性比较研究),1 334例患者。Meta分析结果显示:与传统开放椎弓根螺钉固定比较:微创经皮椎弓根螺钉固定显著减少手术持续时间[SMD-1.11,95%可信区间(-1.63,-0.58)];失血量[WMD-235.71 ml,95%可信区间(-253.12,-218.29)];术后引流量[WMD-209.76 ml,95%可信区间(-254.75,-164.77)],矢状指数[SMD 0.39,95%可信区间(-0.11,0.89)];术后并发症发生率[RR 0.36,95%可信区间(0.23,0.55)]。结论微创经皮椎弓根螺钉固定治疗胸腰椎骨折安全可靠、创伤小、出血少、恢复快、住院时间短、术后并发症少,中期随访对伤椎畸形的矫正和内固定效果与传统开放手术相当。然而,大多数的相关方法和结果不够详细。我们建议根据相关标准报告随机对照试验,提高整个随机对照试验的报告质量和真实性。
Objective To systematically compare the minimally invasive percutaneous and traditional open pedicle screw fixation to the treatment of thoracolumbar fractures in terms of efficacy and complications. Methods A detailed search of several electronic databases was undertaken to identify randomized controlled trials or quasi-randomized controlled trials and comparative observational studies published before 2015 that compared MIPPS technique with the traditional open pedicle screw(TOPS) technique in patients with thoracolumbar fractures. A pooled estimate of the effect size was produced using both random and fixed effects models. Results A quantitative Meta analysis of 28(25 RCTs/q RCTs and 3 retrospectively comparative studies) studies including 1 334 patients was performed. MIPPS was associated with significant duration reductions of surgery(SMD-1.11, 95% CI-1.63,-0.58); blood loss(WMD-235.71 ml, 95% CI-253.12,-218.29); postoperative drainage(WMD-209.76 ml, 95% CI-254.75,-164.77); sagittal index(SMD 0.39, 95% CI-0.11, 0.89); postoperative complication rates(RR 0.36, 95% CI 0.23, 0.55) compared with TOPS. Conclusion The MIPPS technique leads to less blood loss, surgical drain, and better pedicle stability and function when comparing with the TOPS technique. There was no significant difference between the 2 groups with regard to postoperative complications and implant position. However, most of the RCTs, methodology and results were not detailed enough. We suggest reporting RCT according to CONSORT standards as far as possible in order to improve the report quality and authenticity of RCT. The MIPPS technique may achieve perioperative benefits comparing with the TOPS technique.