手术联合置管冲洗引流病灶治疗脊柱结核的Meta分析

Meta-analysis of operation combined with irrigation and drainage of focus lesion in the treatment of spinal tuberculosis

目的:系统分析手术联合置管冲洗引流病灶治疗脊柱结核的治疗效果。方法:两位研究者独立对数据库包括中国知网、万方数据知识服务平台、维普数据库、PubMed、EMbase、Cochrane Library进行文献检索,收集关于手术联合置管冲洗引流病灶治疗脊柱结核的随机对照试验(RCT)与回顾性研究。语种限中、英文。两位研究者独立评价各研究的质量,且将各研究中的术前和术后视觉模拟评分法(visual analogue score,VAS)、Cobb角、血红细胞沉降率(erythrocyte sedimentation rate,ESR)、C-反应蛋白(C-reactive protein,CRP)等提取整理为电子基线表,并将数据通过Review Manager 5.4软件进行Meta分析,评估手术联合置管冲洗引流病灶治疗脊柱结核的效果。结果:共纳入7篇研究论文,191例患者被纳入分析。Meta分析结果显示:手术联合置管冲洗引流病灶治疗脊柱结核术后与术前VAS评分的均数差为5.33(95%CI:4.11~6.55);术后与术前Cobb角的均数差为14.47°(95%CI:11.32°~17.61°);术后与术前ESR均数差为40.20 mm/1 h(95%CI:27.80~52.60);术后与术前C-反应蛋白的均数差为30.44 mg/L(95%CI:12.12~48.76)。结论:手术联合置管冲洗引流病灶治疗脊柱结核有较好的治疗疗效,可有效减轻患者疼痛级别,并且能有效改善患者身体畸形状态和身体状况,提高治愈率。

Objective:To systematically analyze the therapeutic effect of operation combined with irrigation and drainage of focus lesion in the treatment of spinal tuberculosis.Methods:Two researchers independently conducted a literature search in China National Knowledge Infrastructure,Wanfang Date,VIP,PubMed,EMbase and Cochrane Library,and collected randomized controlled trials(RCTs)and retrospective studies on the treatment of spinal tuberculosis by surgery combined with catheter irrigation and drainage.The language was limited to Chinese and English.The two researchers independently evaluated the quality of each study,and extracted the preoperative and postoperative data of visual analogue score(VAS),Cobb angle,Erythrocyte sedimentation rate(ESR),C-reactive protein into an electronic baseline table which were analyzed and synthesized by Review Manager 5.4 software to evaluate the effectiveness of this surgical technique in the treatment of spinal tuberculosis.Results:A total of 7 studies with 191 patients were eventually included in the analysis.Meta-analysis results showed that:the mean difference between postoperative VAS scores and preoperative VAS scores was 5.33(95%CI:4.11-6.55);The mean difference between Cobb angle after operation and Cobb angle before operation was 14.47°(95%CI:11.32°-17.61°);The difference between postoperative ESR and preoperative ESR was 40.20 mm/1 h(95%CI:27.80-52.60);The mean difference between postoperative C-reactive protein and preoperative C-reactive protein was 30.44 mg/L(95%CI:12.12-48.76).Conclusion:Operation combined with irrigation and drainage had a good therapeutic effect in the treatment of spinal tuberculosis,could effectively reduce the pain level of patients and improve the physical deformity and physical condition of patients,thus to improve the cure rate.