保守与手术治疗老年Ⅱ型齿状突骨折疗效的Meta分析

Comparison of efficacy between conservative and surgical treatments of type II odontoid fractures in the elderly:a meta-analysis

[目的]系统评价保守与手术两种方式治疗老年Ⅱ型齿状突骨折的疗效。[方法]计算机检索PubMed,EMBASE,OVID,Science Direct和Cochrane CENTRAL等数据库,纳入关于保守与手术两种方法治疗老年Ⅱ型齿状突骨折疗效比较的随机对照试验(RCTs)或非随机对照试验(non-RCTs)。制定入选和剔除标准,筛选出符合纳入标准的研究,评价纳入研究的方法学质量。利用RevMan5.1(Cochrane Library)进行Meta分析。[结果]共有12篇研究符合纳入标准,共730例患者,保守组441例,手术组289例。Meta分析结果显示:保守组与手术组死亡人数相比,两者差异无统计学意义(P>0.05);而两者不愈合人数相比,前者高于后者(P<0.05)。[结论]保守与手术治疗老年Ⅱ型齿状突骨折都取得了一定的临床疗效;两者死亡人数相比,无显著差异;但两者的不愈合人数相比,保守组高于手术组。

[Objective]To systematically assess the efficacy of conservative treatment in comparison with surgical treatment of type II odontoid fractures in the elderly.[Method]A systematic search of all the studies published was conducted on the Pub Med,EMBASE,OVID,Science Direct,and Cochrane Central databases.Randomized and non-randomized controlled trials that compared between conservative and surgical treatments,and provided data on clinical effects were identified.The included trials were screened out strictly based on the inclusion and exclusion criteria.The quality of the included trials was evaluated.Rev Man 5.1 was used for the data analysis.[Result]Twelve studies involving 730 patients were included.Among the patients,441 underwent conservative treatment and 289 underwent surgical treatment.The results of the meta-analysis indicated no difference in mortality（P〉0.05）.However,a statistically significant difference was observed in the number of nonunions（P〈0.05）.[Conclusion] Both conservative and surgical treatments were demonstrated to be effective for type II odontoid fractures in the elderly.No significant difference in mortality was found between the two treatment groups.The number of nonunions in the conservative treatment group is higher than that in the surgical treatment group.