手术与保守治疗无神经损伤A型胸腰椎爆裂骨折疗效差异的Meta分析

The meta analysis of open surgery versus conservative treatment for thoracolumbar burst fractures without neurological injure:a Meta-analysis

目的通过Meta分析的方法比较手术与保守治疗无神经损伤的A型胸腰椎爆裂骨折的疗效差异。方法检索国内外已发表的病例对照研究,检索数据库包括Embase、Pubmed、Web of Science、Cochrane Library、知网、万方、百度学术、谷歌学术等。根据Cochrane偏倚风险评估标准对符合纳入标准的文献进行质量评价,采用Review manager 5.3软件对提取的数据进行统计学分析。结果共18篇病例对照研究纳入分析,共1 652例患者,其中保守组983例,手术组669例。相对于保守治疗,手术治疗A型胸腰椎爆裂骨折末次随访脊柱后凸角更小(P<0.0001)、椎管狭窄率更低(P<0.0001)、恢复工作用时更短(P<0.0001)。而住院时间(P=0.06)、VAS评分(P=0.72)、ODI评分(P=0.74)、恢复重体力劳动率(P=0.64)和恢复轻体力劳动率(P=0.11)、恢复工作情况(P=0.84)和并发症发生率(P=0.61)等结局指标,差异均无统计学意义。结论手术治疗无神经损伤的A型胸腰椎爆裂骨折相较于保守治疗具有脊柱后凸角小、椎管狭窄率低、恢复工作用时短等优点。

Objective To systematically compare the clinical efficacy of surgery with conservative treatment for type A thoracolumbar burst fractures without neurologic deficit. Methods The studies using case controlled trials to compare surgery with conservative treatment for type A thoracolumbar burst fractures without neurologic deficit were retrieved from Embase、Pubmed、Web of Science、Cochrane Library etc.The Cochrane risk assessment criteria were used to evaluate the quality of the articles that met the inclusion criteria.Data were analyzed with Review Manager 5.3 software. Results Eighteen case controlled studies(involving 1652 cases) were included in meta-analysis.Conservative treatment group consisted of 983 cases,and surgery group consisted of 669 cases.Through comparison,we found last follow-up kyphosis angle(P<0.0001)for surgery was smaller,spinal canal stenosis rate was less(P<0.0001)and time before return to work was shorter(P<0.0001)for surgery group than conservative treatment group.However,there is no statistical difference between two groups on the time in hospital(P=0.06),VAS score(P=0.72),ODI score(P=0.74),heavy physical labor recovery(P=0.64),Light physical labor recovery(P=0.11),return to work ratio(P=0.84)and incidence of complications(P=0.61).Conclusion Surgical treatment of thoracolumbar burst fractures without neurologic deficit has the advantages of less kyphosis angle,lower spinal stenosis rate,and shorter recovery time than conservative treatment.In summary,we believe that the surgical treatment of thoracolumbar burst fractures without neurologic Deficit is better than conservative treatment.