手术与非手术治疗无神经损伤胸腰椎爆裂骨折的Meta分析

Meta analysis of operative versus non-operative treatment for thoracolumbar burst fracture without neurological deficit

目的 对无神经损伤胸腰椎爆裂骨折手术与非手术治疗进行Meta分析及疗效比较.方法 由2名研究者独立检索Pubmed Medline、荷兰医学文摘数据库（Embase）、Cochrane系统综述数据库和临床对照试验数据库、中国生物医学文献数据库（CBM）、万方数据库、中国知网（CNKI）.根据纳入、排除标准筛选各数据库建库至2014年2月发表的文献,并遵循Cochrane指南进行文献质量评价及数据提取. 结果 最终纳入2篇随机对照研究,获取79例患者的临床资料（手术组41例,非手术组38例）进行Meta分析,随访期限最少2年.2篇研究的异质性较大,其中1篇认为随访结束时手术组在疼痛缓解、功能恢复及重返工作方面疗效较好;而另1篇的结果则相反.Meta结果显示,手术组并发症（RR =2.85,95％ CI 0.83 ～9.75）包括再次手术率（RR=8.39,95％CI 1.12 ～62.87）较高. 结论 对于无神经损伤的胸腰椎爆裂骨折,手术与非手术治疗在缓解疼痛、促进功能恢复及患者重返工作方面疗效相似,手术治疗往往带来较多的并发症.

Objective To compare the outcomes of operative with non-operative treatment for thoracolumbar burst fracture without neurological deficit using Meta-analysis.Methods Electronic database were searched from inception to February 2014 by two independent reviewers,including Pubmed Medline,Excerpta Medica Database （Embase）,Cochrane Central Register of Controlled Trials,Chinese Biology Medicine （CBM）,Chinese Wanfang Database,and China National Knowledge Infrastructure （CNKI）.Inclusion and exclusion criteria were applied to select the studies.Quality appraisal and data extraction were based on Cochrane Collaboration guidelines.Results Two randomized controlled trials （RCTs）,which reported outcomes for 79 patients （41 with operative treatment and 38 with nonoperative treatment） at a follow-up of two years or more were included.Between-study heterogeneity was found to be significant,for one reported better results in surgery group concerning pain relief,function recovery and returning to work.However,opposite results were found in another trial.Meta-analysis showed surgery led to higher complication rates （RR =2.85,95% CI 0.83-9.75）,including subsequent surgery （RR =8.39,95% CI 1.12-62.87）.Conclusion Operative and nonoperative managements produce similar results with respect to pain relief,function regain,and returning to work when performed for thoracolumbar burst fractures without neurologic deficit,but operation is often associated with more complications.