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置入固定胸腰椎骨折的文献荟萃

英文题名：Comparison of minimally invasive percutaneous and conventional open pedicle screw fixation for thoracolumbar fractures: a meta-analysis

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

第一作者：薛文

机构：[1]甘肃省人民医院骨科,甘肃省兰州市730000;[2]甘肃中医药大学研究生院,甘肃省兰州市730000;[3]兰州大学第二医院骨2科,甘肃省兰州市730000;[4]甘肃会宁县人民医院,甘肃省会宁县730700

第一机构：甘肃省人民医院骨科,甘肃省兰州市730000

年份：2016

卷号：20

期号：13

起止页码：1961

中文期刊名：中国组织工程研究

外文期刊名：Chinese Journal of Tissue Engineering Research

收录：CSTPCD;;Scopus;北大核心:【北大核心2014】；

语种：中文

中文关键词：胸椎;腰椎;骨折;外科手术,微创性;骨钉;内固定器;组织工程;骨科植入物;脊柱植入物;胸腰椎骨折;微创手术;传统开放手术;椎弓根螺钉;内固定术;并发症发生率;CONSORT声明;报告质量评价

外文关键词：Thoracic Vertebrae; Lumbar Vertebrae; Fractures; Bone; Surgical Procedures; Minimally Invasive; Bone Nails; Internal Fixators; Tissue Engineering

摘要：背景:研究表明,采用切开复位椎弓根螺钉置入固定胸腰椎骨折可获得满意的效果,并得到广泛的推崇,但其在修复术中和修复后存在潜在风险;而微创经皮椎弓根螺钉技术使软组织创伤和并发症降到最低。微创经皮和传统开放椎弓根螺钉置入内固定修复胸腰椎骨折,何种方法更具优势尚无定论。目的:对微创经皮与传统开放椎弓根螺钉置入内固定修复胸腰椎骨折的疗效和术后并发症进行质量评价和荟萃分析。方法:计算机检索Pub Med、The Cochrane Library、CNKI、Wan Fang、CBM及VIP数据库,手工检索中华骨科杂志、中华创伤骨科杂志、中华创伤杂志等。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的对照试验,检索时限均为建库至2015年,并追溯纳入研究所引用的参考文献。由4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,采用Rev Man 5.2软件进行Meta分析。根据CONSORT声明和相关的外科临床评价指标对纳入文献的质量进行综合评价。结果与结论:共纳入28篇文章(25个随机对照试验研究和3个回顾性比较研究),1 285例患者。Meta分析结果显示:与传统开放椎弓根螺钉固定相比,微创经皮椎弓根螺钉置入内固定手术时间短、术中出血量少、住院时间短、术后总体并发症发生率低、病椎高度丢失少(P<0.05)。但术后疼痛等级两者差异无显著性意义(P>0.05)。提示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。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。
BACKGROUND： Open reduction pedicle screw fixation for thoracolumbar fracture could obtain satisfactory effects, and has been extensively used. However, it has potential risk during and after repair. Minimally invasive percutaneous pedicle screw technique minimizes the trauma and complications of soft tissue. It remains poorly understood which is better minimally invasive percutaneous or conventional open pedicle screw fixation for the repair of thoracolumbar fracture.OBJECTIVE： To perform quality evaluation and meta-analysis on curative effect and postoperative complications of minimally invasive percutaneous and conventional open pedicle screw fixation in the treatment of thoracolumbar fractures. METHODS： A detailed search of several electronic databases, including Cochrane Library, Pub Med, Wan Fang, CNKI, VIP and CBM, was undertaken. Simultaneously, Chinese Journal of Orthopaedics, Chinese Journal of Orthopaedic Trauma, and Chinese Journal of Trauma were checked by hand to identify controlled trials regarding minimally invasive percutaneous and conventional open pedicle screw fixation in the treatment of thoracolumbar fractures published from inception to 2015, and the references of the included studies were checked. According to inclusion and exclusion criteria, references were screened, data were extracted and quality was evaluated by four investigators independently. Meta-analysis was conducted using Rev Man 5.2 software. The quality of references of the included controlled trials was assessed with CONSORT statement and some surgery clinical evaluation indexes. RESULTS AND CONCLUSION： We included 28 studies, including 25 randomized controlled trials/quasi-randomized controlled trials and 3 retrospective comparative studies, with 1 285 patients. Meta-analysis results demonstrated that compared with the conventional open pedicle screw, minimally invasive percutaneous pedicle screw fixation could significantly reduce operation time, blood loss, hospital stays, postoperative complication rate and height loss（P〈0.05）. No significant difference in postoperative pain grade was detected between them（P〉0.05）. These results indicate that minimally invasive percutaneous pedicle screw fixation for thoracolumbar fracture was safe and reliable, had small trauma, less blood loss, rapid recovery, short hospital stay, and less postoperative complications. Nevertheless, methods and results of most studies are not detailed enough. We suggested reporting randomized controlled trials according to related standards in order to improve the report quality and authenticity of randomized controlled trials.