Injured vertebra pedicle screw fixation versus short-segment pedicle instrumentation for thoracolumbar fracture: a meta-analysis

doi:10.3969/j.issn.2095-4344.2017.35.026

Abstract

Abstract:

BACKGROUND: Posterior internal fixation is one of the most common methods for thoracolumbar fractures. There is a lack of systematic evaluation about the efficacy of injured vertebra pedicle screw fixation (IVPSF) versus short-segment pedicle instrumentation (SSPI) for thoracolumbar fracture.

OBJECTIVE: To compare the clinical outcomes of IVPSF and SSPI for single thoracolumbar fracture through a meta-analysis.

METHODS: A computer-based on-line research of PubMed, Medline, Embase, Cochrane Library, CNKI, and WanFang databases was performed for the studies regarding IVPSF versus SSPI for thoracolumbar fracture from 1990 to 2016. The randomized controlled trials and cohort studies were collected based on the strict criteria of inclusion and exclusion. A meta-analysis was conducted on Revman5.3 sofeware.

RESULTS AND CONCLUSION: (1) Eleven articles were enrolled, including 5 English and 6 Chinese ones, involving 689 patients (328 cases for IVPSF and 361 cases for SSPI). (2) The meta-analysis indicated that the operation time, blood loss and mean hospital stay showed no significant differences between two groups. IVPSF showed more effective than SSPI in the kyphotic angle correction and anterior vertebral height recovery at postoperation and 1-5 years of follow-up. Moreover, the incidence of postoperative fixation failure in IVPSF was lower than that in SSPI. (3) These findings suggest that IVPSF that reduces the postoperative fixation failure rate for thoracolumbar fractures provides better kyphosis correction and restoration of anterior vertebral height at post-operation and 1-5 years of follow-up.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Thoracic Vertebrae, Lumbar Vertebrae, Fractures, Bone, Internal Fixators, Tissue Engineering

CLC Number:

R318

Mo Ling, Lin Shun-xin, Liang De, Zhang Shun-cong, Yang Zhi-dong, Cui Jian-chao, Jiang Xiao-bing, Jin Da-xiang. Injured vertebra pedicle screw fixation versus short-segment pedicle instrumentation for thoracolumbar fracture: a meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2017, 21(35): 5733-5740.

Figures/Tables 4

2.2 文献方法学质量评估纳入的11篇文献中[6-11]，应用改良Jadad量表评估3篇随机对照试验文献，3分有1篇，5分有1篇，6分1篇；NOS量表评估8篇队列研究，5分1篇，6分3篇，7分2篇，8分2篇。纳入文献基本特征见表1。 2.3 Meta分析结果 2.3.1 平均年龄 6个研究报告了2组患者平均年龄[6-8，11，13，16](图2)，各研究间无统计学异质性(I2=0%)，采用固定效应模型，效应量合并分析指标选用MD。2种手术方式患者的平均年龄差异无显著性意义[MD=1.20，95%CI(-0.43，2.83)，P=0.15]。 2.3.2 手术时间 5个研究报告了2种手术方式的平均手术时间[6-8,11,15](图3)。各组间研究无明显统计学异质性(I2=0%)，采用固定效应模型，效应量合并分析指标选用MD。2种手术方式的平均手术时间差异无显著性意义[MD=-0.9，95%CI(-4.88，3.09)，P=0.66]。 2.3.3 失血量 5个研究报告了2种手术方式的失血量[6-8,11,15](图4)，各研究间无统计学异质性(I2=0%)，采用固定效应模型，效应量合并分析指标选用MD。2种手术方式的平均失血量差异无显著性意义[MD=8.73，95%CI (-10.96，28.42)，P=0.38]。 2.3.4 住院时间 2个研究报告了患者的平均住院时间[6-7](图5)，研究间存在较大统计学异质性(I2=50%)，采用随机效应模型，效应量合并分析指标采用MD。患者平均住院时间差异无显著性意义[MD=1.99，95%CI(-0.78，4.75)，P=0.16]。 2.3.5 后凸畸形情况 9个研究报告2组患者术前骨折椎体Cobb角[6-11,13,15-16](图6)，I2=0%，无统计学异质性，采用固定效应模型，2组患者术前骨折椎体Cobb角差异无显著性意义[MD=0.24，95%CI(-0.75，1.23)，P=0.64]。 8个研究报告了术后Cobb角改善情况[7-11,13,15-16](图7)，I2=90%，有高度异质性，根据纳入研究的类型分为随机对照试验组及队列研究组2个亚组进行分析，其中2个研究为随机对照试验组，各研究间无明显统计学异质性(I2=0%)；6个研究为队列研究组，各研究间存在明显统计学异质性(I2=77%)，因此采用随机效应模型，术后短期Cobb角恢复2组差异均有显著性意义，其中随机对照试验组[MD=-3.30，95%CI(-4.15，-2.45)，P < 0.000 1]、队列研究组[MD=-1.19，95%CI(-2.36，-0.03)，P=0.04]。 8个研究报告了平均1-5年Cobb角随访情况[6-7,9,11,13-16] (图8)，I2=90%，存在明显异质性，根据研究类型进行亚组分析，其中3个研究为随机对照试验组，I2=0%；5个研究为队列研究组，I2=94%，仍存在明显异质性，采用随机效应模型，术后随访Cobb角恢复差异有显著性意义，随机对照试验组[MD=-4.29，95%CI(-5.87，-2.71)，P < 0.000 1]，队列研究组[MD=-7.00，95%CI(-10.89，-3.10)，P=0.000 4]。 2.3.6 骨折椎体前缘恢复情况 8个研究报告了2组患者术前及术后骨折椎体前缘高度压缩率(骨折椎体高度前缘压缩率=骨折椎体前缘高度/骨折椎体相邻上、下椎体前缘高度的均值)[7-11，13，15-16]，见图9，10。术前各研究间无明显统计学异质性(I2=0%)，采用固定效应模型，2组患者术前骨折椎体前缘高度压缩率差异无显著性意义[MD=-0.75，95%CI (-2.57，1.07)，P=0.42]；术后各研究间存在明显异质性(I2=77%)，依据研究类型进行亚组分析，其中2个研究为随机对照试验组，I2=0%；6个研究为队列研究组，I2=74%，采用随机效应模型，2组术后骨折椎体前缘高度压缩率差异均有显著性意义，随机对照试验组[MD=2.93，95%CI (2.37，3.49)，P < 0.000 01]，队列研究组[MD=2.94，95%CI (0.23，5.66)，P=0.03]。 7个研究报告了2组患者1-5年随访骨折椎体前缘高度压缩率随访情况[7,9,11,13-16](图11)，各研究间存在明显异质性(I2=95%)，依据研究类型进行亚组分析，2个研究为随机对照试验组，I2=0%，5个研究为队列研究组，I2=94%，采用随机效应模型，2组差异均有显著性意义，随机对照试验组[MD=5.66，95%CI(4.74，6.57)，P < 0.000 01]，队列研究组[MD=7.63，95%CI(2.11，13.15)，P=0.007]。 2.3.7 内固定失败情况 6个研究出现了内固定失败病例[6,12-16](图12)，各研究间无统计学异质性(I2=0%)，采用固定效应模型。2种手术方式的内固定失败差异有显著性意义[MD=0.11，95%CI(0.04，0.03)，P < 0.000 1]。 "

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