前路与后路内固定治疗成人胸腰段脊柱骨折的系统评价

Systematic review of anterior versus posterior surgical treatJnents of thoracolumbar fractures

目的对前路与后路两种手术入路内固定治疗成人胸腰段脊柱骨折的疗效进行系统评价。方法计算机检索MEDLINE（1966-2006．7）、EMBASE（1966-2006．7）、PubMed（1996—2006．7），Cochrane图书馆（2006年第2期）及中国生物医学数据库（1979-2006．7），手工检索相关的中英文骨科杂志。收集所有前路与后路内固定治疗成人胸腰段脊柱骨折的术后疗效比较的临床随机对照和半随机对照试验，并评价纳入研究的方法学质量。统计软件用Cochrane协作网提供的RevMan4．2．7。结果共纳入侧前方入路与后方人路内固定治疗成人胸腰段脊柱骨折术后疗效的文献6篇，其中随机对照实验（RCT）2个；前瞻性临床队列研究4个。Meta分析表明：与后路手术相比，前路手术组的神经功能恢复更好；稳定性更好，再发生脊柱后凸的Cobb角的度数小；且椎管减压更彻底。后路手术组的并发症发生率高；而2组比较术后重返工作岗位的人数比例无差异。结论与后路手术相比，前路内固定治疗成人胸腰段脊柱骨折时椎管减压更彻底，神经系统功能恢复可能更好，并发症的发生率更低，对脊柱后凸的矫正优于后路组。由于缺乏关于本课题的RCT文章和样本量少的原因，针对2种术式在矫正脊柱畸形，神经功能恢复和术后整体康复等问题上，有待于进一步研究，本文的结论仅具有参考价值。

Objective To evaluate the effectiveness of anterior versus posterior surgical treatments of thoracolumbar fractures. Methods Randomized controlled trims （RCTs） and clinical controlled trials （CCTs） were identified from MEDLINE （ 1966-2006.7 ）, EMBASE （ 1966-2006. 7 ）, PubMed （ 1996- 2006. 7）, Cochrane Library （ Issue 2, 2006 ）. We hand-searched Chinese Journal of Orthopaedy （ from establishment to May 2006） and Orthopaedic Journal of China （from establishment to May 2006）. RCTs and CCTs were included. Data were extracted by two reviewers with designed extraction form. RevMan 4.2. 8 software was used for data analysis. Results Two RCTs and four prospective clinical trials were included. The combined results showed that compare with posterior surgical managerments, anterior approach in the treatment of thoracolumbar fractures proved the less incidence of complications; better neurologic recovery and corrected kyphosis angle; more complete and reliable decompression of the canal. However, there was not difference between the two groups in the general status outcomes. Conclusions To compare with posterior fixation system, anterior surgical managements in the thoracolumbar spinal trauma might be the optimal choices because the lower rates of complications and loss of corrected kyphosis angle; better neurologic recovery, also. Besides, due to the lack of Evidence-based guidelines for the treatment of thoracolumbar spinal injuries, the results which indicated above need further study.