胸椎结核前路与后路手术疗效的荟萃分析

Comparison of clinical outcomes of anterior versus posterior surgery for thoracic tuberculosis:a meta-analysis

[目的]采用荟萃分析评价前路和后路治疗胸椎结核的临床疗效。[方法]对PubMed、Embase、Cochrane、Web of Science、CKNI、维普、万方等7个数据库进行文献检索并手工检索相关杂志。阅读全文提取效应量,采用Revman 5.3软件进行荟萃分析。[结果]从检索的11 618篇文献中选出9篇,均为回顾性队列研究,共纳入病例837例,其中前入路组318例、后入路组519例。荟萃结果显示,两组在手术时间、术中出血量、术后Cobb角矫正度、植骨融合时间、神经功能改善的差异均无统计学意义(P>0.05),但是,后路组在并发症(OR=2.43,95%CI 1.50~3.94,P<0.05)和末次随访Cobb角丢失度(MD=1.16,95%CI 0.36~1.95,P<0.05)均明显优于前路组。[结论]后路手术和前路手术都是行之有效的治疗胸椎结核、恢复神经功能的手术方式,但后路手术的并发症更少,并且更有利于脊柱后凸畸形矫正的维持。

[Objective] To evaluate the clinical efficacy of anterior surgery versus posterior counterpart in the treatment of thoracic spinal tuberculosis.[Methods] Literature retrieval was conducted in seven databases including PubMed,Embase,Cochrane,Web of Science,CKNI,VIP and Wanfang,and relevant journals were manually searched.After reading the full paper and extracting the data met the including criteria,a meta-analysis was conducted by using Revman 5.3 software.[Results] A total of 9 literatures were enrolled into this study from11618 retrieved literatures,all of which were retrospective cohort studies.A total of 837 patients were involved,including 318 cases in the anterior approach group and 519 cases in the posterior approach group.As results of the meta-analysis,there were no statistically significant differences between the two groups in terms of operation time,intraoperative blood loss,postoperative Cobb angle correction,bone graft fusion time,and neurological function improvement(P>0.05),however,the posterior group proved significantly superior to the anterior group in terms of complications [OR=2.43,95%CI 1.50~3.94,P<0.05] and the correct loss in Cobb angle at the latest follow-up [MD=1.16,95%CI0.36~1.95,P<0.05].[Conclusion] Both posterior and anterior surgical operations are effective in treating thoracic tuberculosis and restoring nerve function.By comparison,the posterior surgery have fewer complications and are more beneficial to the maintenance of kyphotic deformity correction.