未经批准:关于前后脊柱融合术(APSF)是否存在争议,而不是后路脊柱融合术(PSF),为治疗严重的胸部青少年特发性脊柱侧凸(AIS)提供益处。本系统评价和荟萃分析比较(1)Cobb角矫正,(2)并发症和再手术率,(3)肺功能,(4)熔接段数,和5)两组患者报告的结果测量(PROMs)。
UNASSIGNED:搜索电子数据库以确定符合以下纳入标准的研究:比较研究(3级或以上),严重的胸曲线(≥70°),年龄≤16岁,AIS病因,≥95%患者群体的Lenke1-4曲线和随访≥1年。使用GRADE和MINORS标准对文献进行质量和偏倚分级。
未经评估:纳入了8项研究,由等级定义为低或中等水平证据。三项研究显示APSF组的曲线校正效果更好;然而,meta分析显示,组间曲线校正无显著差异(95%CI-3.45~12.96,P=0.26).APSF组并发症较多,无统计学意义(95%CI0.53-3.39,P=0.54;I2=0%,P=0.78)。两组都没有重新操作。两项研究报告了肺功能;一项在APSF组中显示出更好的功能,PSF组中其他功能更好。一项研究表明,APSF组中融合的节段较少,然而,在meta分析中没有观察到显著性(95CI-1.65-0.31,P=0.18).三项研究报告了PROM,组间没有差异。
UNASSIGNED:已发现APSF和PSF具有可比的结果。目前的证据不能支持关于对曲线校正的影响的未来实践指南的建议,并发症,重新运营,肺功能或PROMs。
未经证实:III级,三级研究的系统评价。
UNASSIGNED: Debate exists as to whether anterior-posterior spinal fusion (APSF), rather than posterior-only spinal fusion (PSF), provides benefit for treating
severe thoracic adolescent idiopathic scoliosis (AIS). This systematic
review and meta-analysis compare (1) Cobb angle correction, (2) complication and reoperation rate, (3) pulmonary function, (4) number of fused segments, and 5) patient-reported outcome measures (PROMs) in both groups.
UNASSIGNED: Electronic databases were searched to identify studies that met the following inclusion criteria: comparative studies (level 3 or above),
severe thoracic curves (≥ 70°), age ≤ 16, AIS aetiology, Lenke 1-4 curves and follow-up ≥ 1 year for ≥ 95% of patient population. Literature was graded for quality and bias using GRADE and MINORS criteria.
UNASSIGNED: Eight studies were included, defined by GRADE as low or moderate level evidence. Three studies showed superior curve correction in the APSF group; however, the meta-analysis showed no significant difference in curve correction between groups (95% CI - 3.45-12.96, P = 0.26). There were more complications in the APSF group, without statistical significance (95% CI 0.53-3.39, P = 0.54; I 2 = 0%, P = 0.78). There were no re-operations in either group. Two studies reported pulmonary function; one showed better function in the APSF group, the other better function in the PSF group. One study showed fewer fused segments in the APSF group, however, no significance was observed in the meta-analysis (95%CI - 1.65-0.31, P = 0.18). Three studies reported PROMs with no differences reported between groups.
UNASSIGNED: APSF and PSF have been found to have comparable results. The present evidence cannot support recommendations for guidelines on future practice with regards to effect on curve correction, complications, re-operations, pulmonary function or PROMs.
UNASSIGNED: Level III, Systematic
review of Level-III studies.