长节段与短节段内固定治疗退变性脊柱侧弯疗效与并发症的Meta分析

Clinical efficacy and complications of short versus long segments of internal fixation for the treatment of degenerative scoliosis: a meta-analysis

背景:目前治疗退变性脊柱侧弯的手术方式包括单纯减压和减压联合内固定融合,但对于术中固定融合节段的选择仍存在争议,缺乏统一标准,需要更多更可靠的循证医学证据提供参考。目的:运用Meta分析的方法评价长节段与短节段内固定治疗退变性脊柱侧弯的疗效和并发症情况。方法:通过计算机检索2019年2月之前在中国知网、万方、维普中文数据库、CBM、Embase、PubMed、Web of Science、Cochrane图书馆中所有公开发表的,国内外有关长节段与短节段内固定融合治疗退变性脊柱侧弯的随机对照试验及非随机对照试验,并通过手工检索相关会议论文及领域内权威期刊。最终由2位评价员按照Cochrane手册和NOS量表进行文献质量评价后,应用RevMan 5.3软件对最终符合纳入标准的研究数据进行统计分析。结果与结论:①最终共纳入20篇文献,包括1329例患者,其中长节段组601例,短节段组728例;②Meta分析结果显示,长节段内固定在改善冠状面Cobb角(P=0.000 4)、冠状面平衡(P=0.000 2)、Oswestry功能障碍指数(P=0.003)和目测类比评分(P<0.00001)方面更具有优势,但短节段固定的断钉、断棒、内固定松动(P=0.01)和硬脊膜撕裂(P=0.01)等并发症的发生率更低,创伤小,术后住院时间更短(P <0.000 1);③其他疗效指标与并发症分析2组差异无显著性意义(P> 0.05);④提示长节段内固定在脊柱侧凸的矫形效果上优于短节段内固定,但恢复较慢,术后部分并发症的发生率较高,在选择具体手术方案时应综合考虑。

BACKGROUND: Currently, surgical methods for the treatment of degenerative scoliosis include simple decompression and decompression combined with internal fixation. However, there is still controversy over the choice of fixation and fusion segment in surgery, which requires more reliable evidence-based medical evidence for reference. OBJECTIVE: To evaluate the clinical efficacy and complication of short versus long segments of internal fixation for the treatment of degenerative scoliosis using meta-analysis. METHODS: CNKI, Wanfang Database, VIP, CBM, EMBase, PubMed, Web of Science, and Cochrane Library were searched to collect the randomized and non-randomized controlled studies which compared long fusion with short fusion in the treatment of degenerative scoliosis from inception to February 2019. Relevant conference papers and authoritative journals in the field were retrieved manually. The quality of the included studies was assessed by two evaluation members according to the Cochrane collaboration network standard or the Newcastle-Ottawa Scale. The included studies were analyzed by using RevMan 5.3 software. RESULTS AND CONCLUSION:(1) A total of 20 articles were included, involving a sample of 1 329 individuals. Long segment group consisted of 601 cases, and short segment group consisted of 728 cases.(2) The meta-analysis results showed that long-segment internal fixation surgery had better improvement of coronal Cobb angle(P=0.000 4), coronal balance(P=0.000 2), Oswestry disability index(P=0.003) and visual analogue scale score(P < 0.000 01). However, the incidence of implant failure(P=0.01) and dural tear(P=0.01) in short segment group was lower than that in long segment group. The short segment group had small trauma and shorter hospital stays after surgery(P < 0.000 1).(3) There was no statistical difference in other therapeutic indicators and complications between the two groups(P > 0.05).(4) These findings verify that long-segment internal fixation is superior to short-segment internal fixation in the correction of scoliosis, but the recovery is slow and the incidence of some complications after operation is high. It should be considered comprehensively when selecting specific surgical procedures.