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[1]何國(guó)忠,應(yīng)永生,俞春生,等.前路與后路一期病灶清除植骨內(nèi)固定 治療胸腰椎結(jié)核的Meta分析[J].中醫(yī)正骨,2018,30(08):29-35.
　HE Guozhong,YING Yongsheng,YU Chunsheng,et al.Primary debridement combined with bone grafting and internal fixation through anterior approach versus posterior approach for treatment of thoracolumbar tuberculosis:a meta analysis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(08):29-35.
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前路與后路一期病灶清除植骨內(nèi)固定 治療胸腰椎結(jié)核的Meta分析()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期數(shù):
2018年08期
頁(yè)碼:
29-35
欄目:
文獻(xiàn)研究
出版日期:
2018-08-20

文章信息/Info

Title:
Primary debridement combined with bone grafting and internal fixation through anterior approach versus posterior approach for treatment of thoracolumbar tuberculosis:a meta analysis
作者:
何國(guó)忠1; 應(yīng)永生1; 俞春生1; 劉丙根2
1.浙江省永康市骨科醫(yī)院,浙江 永康 321300; 2.浙江省寧波市第二醫(yī)院,浙江 寧波 315010
Author(s):
HE Guozhong1; YING Yongsheng1; YU Chunsheng1; LIU Binggen2
1.Yongkang Orthopedic Hospital,Yongkang 321300,Zhejiang,China 2.The Second Hospital of Ningbo City,Ningbo 315010,Zhejiang,China
關(guān)鍵詞:
結(jié)核; 脊柱;  胸椎;  腰椎;  手術(shù)入路;  清創(chuàng)術(shù);  骨移植;  Meta分析;  系統(tǒng)評(píng)價(jià)
Keywords:
tuberculosis; spinal;  thoracic vertebrae;  lumbar vertebrae;  operative approach;  debridement;  bone transplantation;  Meta-analysis;  systematic review
摘要:
比較前路與后路一期病灶清除植骨內(nèi)固定治療胸腰椎結(jié)核的臨床療效和安全性。方法:應(yīng)用計(jì)算機(jī)檢索Cochrane Library、PubMed、Ovid、Spinger Link、Elsevier、CNKI、萬(wàn)方建庫(kù)至2017年7月國(guó)內(nèi)外公開(kāi)發(fā)表的前路一期病灶清除植骨內(nèi)固定(前路組)與后路一期病灶清除植骨內(nèi)固定(后路組)治療胸腰椎結(jié)核的隨機(jī)對(duì)照研究、前瞻性或回顧性隊(duì)列研究文獻(xiàn)。由2名研究者獨(dú)立篩選文獻(xiàn)并提取資料,采用紐卡斯?fàn)?渥太華量表(the Newcastle Ottawa Scale,NOS)進(jìn)行文獻(xiàn)方法學(xué)質(zhì)量評(píng)價(jià)后,采用RevMan5.0軟件進(jìn)行Meta分析。結(jié)果:最初檢出2794篇相關(guān)文獻(xiàn),經(jīng)篩選最終納入13篇文獻(xiàn),其中英文文獻(xiàn)6篇、中文文獻(xiàn)7篇; 6篇文獻(xiàn)為前瞻性隊(duì)列研究文獻(xiàn),6篇為回顧性隊(duì)列研究文獻(xiàn),1篇為隨機(jī)對(duì)照研究文獻(xiàn); 8篇文獻(xiàn)NOS評(píng)價(jià)分?jǐn)?shù)為8分,5篇文獻(xiàn)為7分; 共涉及1190例患者,其中前路組576例、后路組614例。Meta分析結(jié)果顯示,2組手術(shù)時(shí)間、術(shù)中出血量、住院時(shí)間、末次隨訪時(shí)脊柱后凸Cobb角丟失度數(shù)比較,組間差異均無(wú)統(tǒng)計(jì)學(xué)意義[WMD=-2.08,95%CI(-39.59,35.43); WMD=-35.50,95%CI(-103.16,32.16); WMD=0.69,95%CI(-2.06,3.43); WMD=0.15,95%CI(-0.44,0.73)]; 前路組的脊柱后凸Cobb角矯正角度明顯小于后路組[WMD=-2.14,95%CI(-3.22,-1.06)],植骨融合時(shí)間短于后路組[WMD=-0.21,95%CI(-0.35,-0.07)],并發(fā)癥發(fā)生率高于后路組[OR=1.67,95%CI(1.02,2.72)]。結(jié)論:與前路一期病灶清除植骨內(nèi)固定相比,后路一期病灶清除植骨內(nèi)固定治療胸腰椎結(jié)核,能更好地矯正脊柱后凸畸形,且并發(fā)癥少,但其植骨融合時(shí)間比前路手術(shù)長(zhǎng)。
Abstract:
To investigate the curative effect and safety of primary debridement combined with bone grafting and internal fixation through anterior approach versus posterior approach for treatment of thoracolumbar tuberculosis.Methods:All the randomized controlled trial(RCT)articles,prospective cohort study articles and retrospective cohort study articles about primary debridement combined with bone grafting and internal fixation through anterior approach(anterior approach group)versus posterior approach(posterior approach group)for treatment of thoracolumbar tuberculosis that published at home and abroad included from database establishing to July 2017 were retrieved from Cochrane Library,Pubmed,Ovid,Spinger Link,Elsevier,China national knowledge internet and WanFang Data through computer.The articles were screened and the information was extracted independently by two searchers.The methodological quality of research in the articles was evaluated according to the Newcastle-Ottawa scale(NOS)and a Meta-analysis was conducted by using RevMan 5.0 software.Results:Two thousand seven hundred and ninety-four articles were searched out.After screening,13 articles(6 English articles and 7 Chinese articles)were included in the final analysis,including 6 prospective cohort study articles,6 retrospective cohort study articles and 1 RCT article,576 patients in anterior approach group and 614 patients in posterior approach group,and the NOS scores were 8 points in 8 articles and 7 points in 5 articles.The results of Meta-analysis demonstrated that there was no statistical difference in operative time,intraoperative blood loss,hospital stay and loss of spinal kyphotic Cobb's angle at last follow-up between the 2 groups(WMD=-2.08,95%CI(-39.59,35.43); WMD=-35.50,95%CI(-103.16,32.16); WMD=0.69,95%CI(-2.06,3.43); WMD=0.15,95%CI(-0.44,0.73)).The correction degree of spinal kyphotic Cobb's angle was smaller,the time of bone graft fusion was shorter and the postoperative complication incidences were higher in anterior approach group compared to posterior approach group((WMD=-2.14,95%CI(-3.22,-1.06); WMD=-0.21,95%CI(-0.35,-0.07); OR=1.67,95%CI(1.02,2.72)).Conclusion:Primary debridement combined with bone grafting and internal fixation through posterior approach can better correct the kyphotic deformity compared to primary debridement combined with bone grafting and internal fixation through anterior approach in treatment of thoracolumbar tuberculosis,and it has less postoperative complications.However,the former needs longer bone graft fusion time compared to the latter.

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中醫(yī)正骨2018年8月第30卷第8期 J Trad Chin Orthop Trauma,2018,Vol.30,No.8(總595)
(總596)中醫(yī)正骨2018年8月第30卷第8期 J Trad Chin Orthop Trauma,2018,Vol.30,No.8
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通訊作者:劉丙根 E-mail:[email protected]
更新日期/Last Update: 2018-08-31