短节段椎弓根钉内固定结合经伤椎椎体强化治疗胸腰椎骨折临床疗效的Meta分析

Short-segment Pedicle Instrumentation with Intravertebral Augmentation in Management of Thoracolumbar Fractures:Meta-analysis of Complications

目的对经伤椎椎体强化技术(包括经椎弓根植骨、经伤椎椎体内融合器技术以及伤椎椎体成形技术)是否可降低胸腰椎骨折短节段椎弓根钉内固定术后矫正度数的丢失和内固定断裂的发生率进行系统评价。方法检索MEDLINE、EMBASE、中国生物医学数据库,手工检索中文相关杂志。收集所有采用后路短节段椎弓根钉内固定结合经伤椎椎体强化技术治疗胸腰椎骨折的实验性研究(随机对照研究、非随机对照研究)和观察性研究(队列研究、病例对照研究),并对纳入研究的方法学质量进行评估。利用Cochrane协作网提供的RevMan 5.0.18软件进行统计学分析。结果共纳入符合入选标准的文献8篇,包括英文文献7篇,中文文献1篇。其中随机对照研究1篇,观察性研究7篇。共包括442例患者,其中经伤椎椎体强化组包含216例患者,无经伤椎椎体强化组包含226例患者。方法学质量评价结果显示,1篇随机对照研究为高质量,7篇观察性研究中4篇为高质量,3篇为低质量。Meta分析结果显示,经伤椎椎体强化组与无经伤椎椎体强化组在术后矫正度数丢失和内固定失败发生率方面均无显著性差异。结论经伤椎椎体强化并不能降低胸腰椎骨折短节段椎弓根钉内固定术后矫正度数的丢失和内固定失败的发生率。

Objective To evaluate the efficacy of intravertebral augmentation which including transpedicular bone graft, transpedicle body augmenter and vertebroplasty in preventing the correction loss and implant failure of short-segment pedicle instrumentation for thora- columbar fractures through meta-analysis. Methods Experimental studies （randomized controlled trails, non-randomized controlled trails） and observational studies （cohort studies, case control studies） related with application of posterior short-segment pedicle instrumentation with intravertebral augmentation for thoracolumbar fractures were searched from Pubmed, EMBASE and CNKI according to the inclusion and exclusion criteria, and hand-searched in Chinese and English journals. RevMan 5.0.18 provided by Cochrane was used to analyse the da- ta. Results 1 randomized controlled trail and 7 observational studies were included. There were 442 patients, in which 216 patients were with and 226 patients without intravertebral augmentation. There was no significant difference in correction loss and risk of implant failure between these two groups. Conclusion Intravertebral augmentation does little about the risk of correction loss and implant failure associated with oosterior short-segment oedicle instrumention for oatients with thoraculumbar fractures.