前路齿状突螺钉固定与后路寰枢椎融合修复齿状突骨折的Meta分析

摘要

BACKGROUND:Many studies concern the comparison of anterior screw fixation and posterior cervical fusion for odontoid fractures, but the sample size of many studies has limitations. There is lack of objective evaluation on advantages and disadvantages of two surgical methods. OBJECTIVE:This is a meta-analysis to compare the clinical results between anterior screw fixation versus posterior cervical fusion for odontoid fractures. METHODS:A systematic search of al the studies published was conducted on the PubMed, the Cochrane Central Register of Control ed Trials (CENTRAL), EMbase, the ISI Web of Knowledge Database, CNKI, VIP, CMB and Wanfang databases. Randomized and non-randomized control ed trials that compared between anterior and posterior approaches for odontoid fracture were identified from database foundation to March 1, 2016. The references were also searched by hand. Meta-analyses were performed by using the Rev-Man 5.3 software, provided by the Cochrane Col aboration. RESULTS AND CONCLUSION:(1) Twelve studies involving 514 patients were included. Among the patients, 287 underwent anterior approach and 227 underwent posterior approach. (2) The results of the meta-analysis indicated that, compared with posterior approach, anterior approach has advantages of less blood loss, shorter operative time, and a smal degree of cervical rotation injury (P<0.05). No statistical difference was determined in bone union and complication rate (P>0.05). (3) These results suggested that both anterior and posterior approaches were demonstrated to be effective for odontoid fractures. Anterior screw fixation had obvious advantages:less bleeding, short operating time, smal trauma and less spine injury. Thus, it is an ideal procedure to treat odontoid fractures. However, the operative approach should be chosen individual y in clinical work.%背景：目前有关前路齿状突螺钉固定与后路寰枢椎融合修复齿状突骨折疗效比较的文献较多，但大多研究的样本量存在局限，对于两者的优缺点缺乏客观评价。　　目的：系统评价前路齿状突螺钉固定与后路寰枢椎融合修复齿状突骨折的临床疗效。　　方法：计算机检索PubMed，the Cochrane Central Register of Control ed Trials(CENTRAL)、EMbase、the ISI Web of Knowledge Database、CNKI、VIP、CMB、万方数据库。纳入关于前路齿状突螺钉固定与后路寰枢椎融合修复齿状突骨折疗效比较的随机对照试验或非随机对照试验。检索时间均为建库时间至2016-03-01。手检纳入文献的参考文献。利用Cochrane协作网提供的Rev-Man 5.3软件进行Meta分析。　　结果与结论：①有12篇研究符合纳入标准，共514例患者，前路组287例，后路组227例；②Meta 分析结果显示，2组手术时间、术中出血量及术后颈部旋转度相比，前路组优于后路组(P<0.05)；骨折愈合率、手术并发症发生率相比，两者差异无显著性意义(P>0.05)；③结果提示，前路齿状突螺钉固定与后路寰枢椎融合修复齿状突骨折均有一定疗效，前路手术在不增加术后并发症、保证骨折愈合率的情况下，具有手术时间短、出血少、创伤小、颈椎活动功能损伤小等优势，是较理想的修复方式。但在临床诊疗过程中，仍需结合患者病情综合判断。