[1]何国忠,应永生,俞春生,等.前路与后路一期病灶清除植骨内固定 治疗胸腰椎结核的Meta分析[J].中医正骨,2018,30(08):29-35.
　HE Guozhong,YING Yongsheng,YU Chunsheng,et al.Primary debridement combined with bone grafting and internal fixation through anterior approach versus posterior approach for treatment of thoracolumbar tuberculosis:a meta analysis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(08):29-35.
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前路与后路一期病灶清除植骨内固定 治疗胸腰椎结核的Meta分析()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期数:
2018年08期
页码:
29-35
栏目:
文献研究
出版日期:
2018-08-20

文章信息/Info

Title:
Primary debridement combined with bone grafting and internal fixation through anterior approach versus posterior approach for treatment of thoracolumbar tuberculosis:a meta analysis
作者:
何国忠1; 应永生1; 俞春生1; 刘丙根2
1.浙江省永康市骨科医院,浙江 永康 321300; 2.浙江省宁波市第二医院,浙江 宁波 315010
Author(s):
HE Guozhong1; YING Yongsheng1; YU Chunsheng1; LIU Binggen2
1.Yongkang Orthopedic Hospital,Yongkang 321300,Zhejiang,China 2.The Second Hospital of Ningbo City,Ningbo 315010,Zhejiang,China
关键词:
结核; 脊柱;  胸椎;  腰椎;  手术入路;  清创术;  骨移植;  Meta分析;  系统评价
Keywords:
tuberculosis; spinal;  thoracic vertebrae;  lumbar vertebrae;  operative approach;  debridement;  bone transplantation;  Meta-analysis;  systematic review
摘要:
比较前路与后路一期病灶清除植骨内固定治疗胸腰椎结核的临床疗效和安全性。方法:应用计算机检索Cochrane Library、PubMed、Ovid、Spinger Link、Elsevier、CNKI、万方建库至2017年7月国内外公开发表的前路一期病灶清除植骨内固定(前路组)与后路一期病灶清除植骨内固定(后路组)治疗胸腰椎结核的随机对照研究、前瞻性或回顾性队列研究文献。由2名研究者独立筛选文献并提取资料,采用纽卡斯尔-渥太华量表(the Newcastle Ottawa Scale,NOS)进行文献方法学质量评价后,采用RevMan5.0软件进行Meta分析。结果:最初检出2794篇相关文献,经筛选最终纳入13篇文献,其中英文文献6篇、中文文献7篇; 6篇文献为前瞻性队列研究文献,6篇为回顾性队列研究文献,1篇为随机对照研究文献; 8篇文献NOS评价分数为8分,5篇文献为7分; 共涉及1190例患者,其中前路组576例、后路组614例。Meta分析结果显示,2组手术时间、术中出血量、住院时间、末次随访时脊柱后凸Cobb角丢失度数比较,组间差异均无统计学意义[WMD=-2.08,95%CI(-39.59,35.43); WMD=-35.50,95%CI(-103.16,32.16); WMD=0.69,95%CI(-2.06,3.43); WMD=0.15,95%CI(-0.44,0.73)]; 前路组的脊柱后凸Cobb角矫正角度明显小于后路组[WMD=-2.14,95%CI(-3.22,-1.06)],植骨融合时间短于后路组[WMD=-0.21,95%CI(-0.35,-0.07)],并发症发生率高于后路组[OR=1.67,95%CI(1.02,2.72)]。结论:与前路一期病灶清除植骨内固定相比,后路一期病灶清除植骨内固定治疗胸腰椎结核,能更好地矫正脊柱后凸畸形,且并发症少,但其植骨融合时间比前路手术长。
Abstract:
To investigate the curative effect and safety of primary debridement combined with bone grafting and internal fixation through anterior approach versus posterior approach for treatment of thoracolumbar tuberculosis.Methods:All the randomized controlled trial(RCT)articles,prospective cohort study articles and retrospective cohort study articles about primary debridement combined with bone grafting and internal fixation through anterior approach(anterior approach group)versus posterior approach(posterior approach group)for treatment of thoracolumbar tuberculosis that published at home and abroad included from database establishing to July 2017 were retrieved from Cochrane Library,Pubmed,Ovid,Spinger Link,Elsevier,China national knowledge internet and WanFang Data through computer.The articles were screened and the information was extracted independently by two searchers.The methodological quality of research in the articles was evaluated according to the Newcastle-Ottawa scale(NOS)and a Meta-analysis was conducted by using RevMan 5.0 software.Results:Two thousand seven hundred and ninety-four articles were searched out.After screening,13 articles(6 English articles and 7 Chinese articles)were included in the final analysis,including 6 prospective cohort study articles,6 retrospective cohort study articles and 1 RCT article,576 patients in anterior approach group and 614 patients in posterior approach group,and the NOS scores were 8 points in 8 articles and 7 points in 5 articles.The results of Meta-analysis demonstrated that there was no statistical difference in operative time,intraoperative blood loss,hospital stay and loss of spinal kyphotic Cobb's angle at last follow-up between the 2 groups(WMD=-2.08,95%CI(-39.59,35.43); WMD=-35.50,95%CI(-103.16,32.16); WMD=0.69,95%CI(-2.06,3.43); WMD=0.15,95%CI(-0.44,0.73)).The correction degree of spinal kyphotic Cobb's angle was smaller,the time of bone graft fusion was shorter and the postoperative complication incidences were higher in anterior approach group compared to posterior approach group((WMD=-2.14,95%CI(-3.22,-1.06); WMD=-0.21,95%CI(-0.35,-0.07); OR=1.67,95%CI(1.02,2.72)).Conclusion:Primary debridement combined with bone grafting and internal fixation through posterior approach can better correct the kyphotic deformity compared to primary debridement combined with bone grafting and internal fixation through anterior approach in treatment of thoracolumbar tuberculosis,and it has less postoperative complications.However,the former needs longer bone graft fusion time compared to the latter.

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备注/Memo:
通讯作者:刘丙根 E-mail:450413369@qq.com
更新日期/Last Update: 2018-08-31