BACKGROUND: Although there are many studies comparing different surgical approaches for the patients with thoracolumbar burst fracture who need a surgical treatment, there are no multi-center large-scale randomized controled studies to reach a conclusion with high evidence level. This makes it necessary to do a meta-analysis with the existing studies to compare anterior and posterior approaches in treatment of thoracolumbar burst fracture. n OBJECTIVE:To analyze the differences of anterior and posterior approaches for thoracolumbar burst fracture and provide guidance for the further operative treatments through a literature retrieval. n METHODS: An online retrieval of PubMed, Medline, Elsevier, Wanfang and CNKI databases was performed for articles about the anterior and posterior approaches for thoracolumbar burst fracture, with the key words of “thoracolumbar fracture, randomized controled trial, spinal fracture, RCT, anterior and posterior” in English, and “thoracolumbar fracture, anterior, posterior, spine” in Chinese. We compared the operative time, total blood loss, loss of Cobb angle, improvement in Frankel grading, and loss of the vertebral height between the anterior and posterior surgical approaches. n RESULTS AND CONCLUSION: Finaly 18 randomized controled trials with a total of 925 patients were included. There were 459 cases in anterior approach group and 466 cases in posterior approach group. The anterior approach cost 36.47 minutes longer than posterior approach and the blood loss in the anterior approach group was 432.58 mL more than the posterior approach group. Compared with the posterior approach group, the loss of Cobb angle was 3.41° lower, the improvement of Frankel grading was 0.33° higher, and the loss of vertebral height was 1.76 mm lower in the anterior approach group. There were significant differences in the operative time, total blood loss, loss of Cobb angle, improvement in Frankel grading and loss of vertebral height between the anterior and posterior surgical approaches (P < 0.01). Although the anterior approach has disadvantages such as long operative time, more intraoperative blood loss, and high technical requirement, the good short-term and long-term results make it worthwhile to apply for the treatment of thoracolumbar burst fractures.%背景：对于需要手术修复的胸腰段脊柱爆裂骨折患者，虽然目前有大量的研究比较脊柱前路手术与后路手术的效果，但还没有大规模多中心随机对照研究证明其优劣。这使胸腰段爆裂骨折前后路手术比较的Meta分析研究成为必要。n 目的：通过分析胸腰段爆裂性骨折前路及后路手术的文献，对两种修复方式进行系统评价，以指导胸腰段爆裂性骨折修复方式的选择。n 方法：检索Pubmed、Medline、Elseveir、万方、CNKI 等数据库，以“thoracolumbar fracture”，“randomized controled trial”，“spinal fracture”，“RCT”，“anterior”，“posterior”，“胸腰段骨折”，“前路”，“后路”，“脊柱”等关键词查找脊柱胸腰段骨折前后路手术比较的研究论文，并利用Revman 5.3荟萃分析软件对文献中手术时间、术中出血量、Cobb 角丢失角度、Frankel 分级改善程度以及椎体高度丢失率等数据进行系统评价。n 结果与结论：最后筛选的文献有18篇，总病例925例，其中前路手术组459例，后路手术组466例。前路手术时间较后路手术时间平均多36.47 min，前路手术组出血量较后路手术组平均高出432.58 mL，前路手术组Cobb角丢失角度较后路手术组平均低3.41°，前路手术组 Frankel 分级改善程度较后路手术组平均高0.33级，前路手术组椎体高度丢失程度较后路手术组椎体高度丢失平均少1.76 mm，两组手术时间、术中出血量、Cobb 角丢失角度、Frankel 功能分级改善程度以及椎体高度丢失率差异均有显著性意义(P <0.01)。提示前路手术虽然有手术时间长、术中出血量多、技术难度大等缺点，但因其优良的近期与远期效果，在有条件的医院应该优先应用于胸腰段脊柱爆裂性骨折的修复。
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