先天性脊柱侧凸合并脊髓纵裂手术治疗的Meta分析

Corrective surgery for patients with congenital scoliosis and spinal cord malformation:a meta-analysis

[目的]采用系统综述及Meta分析评价手术治疗先天性脊柱侧凸合并脊髓纵裂的有效性和安全性,为先天性脊柱侧凸合并脊髓纵裂的治疗提供有益的参考依据。[方法]通过检索Pub Med、Embase、CNKI等中英文数据库,根据制定的纳入和排除标准筛选文献进行疗效分析。[结果]最终纳入分析的文献共有9篇,总样本量为218例。森林图结果显示,手术前后的冠状面Cobb角差异有统计学意义,均值差的合并标准化统计量为33.83（95%CI：23.09∽44.57,P〈0.001）,而手术前后的正常胸后凸差异则无统计学意义,合并统计量为3.35（95%CI：-3.69∽10.39P=0.351）。此外,还对手术并发症的发生率进行合并,结果提示手术并发症的发生率为14.53%（95%CI：6.54%∽28.16%）。[结论]手术治疗先天性脊柱后凸合并脊髓纵裂可有效地矫正冠状面的Cobb角,骨性纵隔切除并未增加术后并发症发生率,截骨矫形可能更有利于提高矫形率,但仍需要更高质量的研究加以证实。

[ Objective] To explore and evaluate safety and efficacy of corrective surgery for patients with congenital scolio- sis and spinal cord malformation by conducting a systematic review and meta analysis, with the aim of providing the evidences and theoretical basis for the treatment of congenital scoliosis and spinal cord malformation. [ Methods ] By searching the data- bases of PubMed, Embase, CNKI, the literature was selected based on the inclusion and exclusion criteria for analy- sis. Methodological index for non - randomized studies （MINORS） was used for quality analysis. Data were statistically analyzed by meta regression analysis method. P 〈 0. 05 was set as having significant difference. [ Results ] A total of 9 literatures was in- cluded in the analysis within a total sample size of 218. The forest plots demonstrated that the difference of coronal Cobb angle be- tween preoperation and postoperation was significant with the combined standard statistics of mean difference of 34. 24 （95% CI： 22. 12 -78. 91, P 〈0. 001 ） . While no significant difference was found for the normal kyphosis between preoperation and postoperation, with the combined standard statistics of mean difference of 3.35 （95% CI： -3.69 -- 10. 39 P = 0. 351 ） . On the other hand, the rate of postoperative complication was 14. 53% （95% CI： 6. 54% - 28.16% ） . [ Conclusion] The correc- tive surgery is effective for congenital scoliosis and spinal cord manformation. It can correct the coronal Cobb angle effectively, meanwhile postoperatively complication rate will not be increased by osteomediastinal resection. However, because of the rela- tively small sample size and non - randomized controlled trials in this study, more larger RCT reseach are still needed in the fu- ture.