前入路与后入路手术比较治疗胸腰椎爆裂性骨折的 Meta 分析

摘要

Objective:To evaluate efficacy of anterior versus posterior approach for treatment of thoracolumbar burst frac-tures. Methods:The PubMed,EMBASE,Cochrane Central Register of Controlled Trials and MEDLIME databases were searched,with no language restrictions,for RCTs or quasi - RCTs,additional references were obtained from reviewed articles. The data were analyzed by RevMan 5. 0. 2 software. Results:Seven trails involving a total of 331 participants met the inclusion criteria. There were no significant differences between groups in the canal encroachment,Cobb angle,Frankel scores,return to workandcomplications[MD = - 8. 02,95% CI( - 17. 33,0. 92),P = 0. 08;MD = - 0. 06,95% CI( - 0. 62,0. 51),P =0. 84;RD = 0. 06,95% CI( - 0. 07,0. 19),P = 0. 38;RD = - 0. 02,95% CI( - 0. 16,0. 13),P = 0. 80]. Compared with ante-rior approach,posterior approach signi?cantly decreased operative time,blood loss and surgical cost[MD = 310. 67,95% CI ( 26. 38,594. 96),P = 0. 03;MD = 17. 17,95% CI(5. 78,28. 57),P = 0. 003;MD = 15. 53,95% CI(6. 72,24. 34),P =0. 0006]. Conclusion:The posterior approach may be more effective than the anterior approach. However,more high - quality, randomized controlled trials are required to compare these approaches.%目的：系统评价前入路与后入路两种不同手术治疗胸腰椎爆裂性骨折的疗效与安全性。方法：通过检索PubMed，EMBASE，Cochrane Central Register of Controlled Trials，MEDLIME 等数据库，全面收集前入路与后入路手术治疗腰椎滑脱症的随机、半随机对照试验（RCT，quasi - RCT）结果，并用 RevMan 5.0.2软件进行 Meta 分析。结果：纳入7个试验共331例患者。前入路和后入路手术治疗胸腰椎爆裂性骨折的侵占程度、Cobb 角、Frankel 分级及重返工作岗位的患者数比较，差异无统计学意义[ MD ＝-8.02，95% CI（-17.33，0.92），P ＝0.08；MD ＝-0.06，95% CI （-0.62，0.51），P ＝0.84；RD ＝0.06，95% CI（-0.07，0.19），P ＝0.38；RD ＝-0.02，95% CI（-0.16，0.13），P ＝0.80]。前入路组与后入路组治疗胸腰椎爆裂性骨折的术中出血量、手术时间及手术费用比较，差异有统计学意义[MD ＝310.67，95% CI（26.38，594.96），P ＝0.03；MD ＝17.17，95% CI（5.78，28.57），P ＝0.003；MD ＝15.53，95% CI （6.72，24.34），P ＝0.0006]；但两组间的其他不良反应发生率差异无统计学意义。结论：后入路手术治疗胸腰椎爆裂性骨折比前入路手术更有效，能减少术中出血量、手术时间及手术费用。