Sextent系统下微创经皮与开放椎弓根螺钉内固定术治疗胸腰椎骨折疗效比较的Meta分析

Comparison of the clinical safety and efficacies of the Sextant percutaneous pedicle screw fixation device and open pedicle screw fixation for thoracolumbar fractures: a meta- analysis

[目的]系统评价Sextent系统下微创经皮(Sextant percutaneous pedicle screw fixation,SPPSF)与开放椎弓根螺钉内固定术(open pedicle screw fixation,OPSF)治疗胸腰椎骨折疗效及安全性。[方法]计算机检索PubMed、EMbase、WanFang Data、VIP和CNKI数据库,收集分别经SPPSF与OPSF治疗胸腰椎骨折的随机或非随机同期对照试验,并手检相关会议论文及追溯纳入文献的参考文献。根据纳入标准进行筛选文献、资料提取、质量评价后,采用Revman 5.2版软件进行Meta分析。[结果]最终纳入随机对照试验1篇,病例对照试验7篇,共417例患者。Meta分析结果显示:与OPSF相比较,SPPSF手术时间短[MD=-28.14,95%CI(-32.14,-24.14),P<0.000 01],术中出血量少[MD=-224.71,95%CI(-277.02,-172.40),P<0.000 01]、术后引流量少[MD=-331.30,95%CI(-392.09,-270.52),P<0.000 01]、下床活动早[MD=-11.95,95%CI(-17.78,-6.13),P<0.000 01]、住院天数少[MD=-8.65,95%CI(-12.56,-4.74),P<0.000 01]和并发症少[OR=0.26,95%CI(0.09,0.69),P=0.007],而SPPSF手术前后伤椎自身Cobb角改善程度不及OPSF,差异具有统计学意义[MD=-0.46,95%CI(-3.72,2.97),P=0.78]。两种术式的术后切口疼痛VAS评分和手术节段的Cobb角改变差异无统计学意义。[结论]SPPSF手术方式的安全性较高,但手术前后伤椎自身Cobb角改善程度不及OPSF,且两种术式的术后切口疼痛VAS评分和手术前后手术节段的Cobb角改善方面相似。

[ Objective] To compare the clinical safety and efficacies of the Sextant percutaneous pedicle screw fixation （SPPSF） device and open pedicle screw f＇rxation （OPSF） for thoracolumbar fractures. [ Method] Databases including PubMed, EMbase,WanFang Data,VIP and CNKI were searched to collect data on clinical trials of the clinical safety and efficacies of the SPPSF device and OPSF for thoracolumbar fractures. Relevant proceedings and references of the included studies were also re- trieved manually. Studies were screened to include those that met the inclusion criteria, the data from the selected studies were extracted, and the outcomes of the methods used in the included studies were assessed. Meta - analysis was then conducted using the RevManS. 2 software. [ Result] One randomized controlled trim and 7 concurrent clinical controlled trials involving 417 pa- tients were finally included. Meta - analysis showed that compared with OPSF, treatment with the SPPSF device had shorter oper- ation time （ MD, - 28.14 ; 95% confidence interval [ CI ], - 32. 14, - 24. 14 ; P 〈 0. 000 01 ）, lesser intraoperative bleeding （ MD, - 224.71 ;95 % CI, - 277.02, - 172.40 ; P 〈 0.000 01 ）, lesser postoperative drainage （ MD, - 331.30 ; 95 % C I, - 392.09, - 270.52 ;P 〈 O. 000 O1 ）, earlier ambulation （ MD, - 11.95 ;95 % CI, - 17.78, - 6.13 ;P 〈 O. 000 O1 ）, shorter has- pital duration （ MD, - 8.65 ;95% CI, - 12.56, - 4.74 ;P 〈 0. 000 01 ） and fewer complications （ odds ratio,0.26 ;95% C1,0. 09 -0.69 ;P = 0.007 ）. However, the improvement in the Cobb angle of the injured vertebrae was lesser with the SPPSF device than with OPSF, and the difference was statistically significant （ MD, - 0.46,95% CI, - 3.72,2.97 ;P =0. 78）. Additionally, there were no differences between the 2 groups in the visual analogue scale （VAS） score for incision pain and change in the Cobb angle of the operated segment. [ Conclusion] The SPPSF device is safer but the improvement in the Cobb angle of the in- jured vertebrae was lesser than that after OPSF,with a statistically significant difference. Additionally,there were no differencesbetween the 2 groups in the VAS score for incision pain and change in the Cobb angle of the operated segment.