目的:本研究的目的是比较强直性脊柱炎(AS)伴胸腰段后凸畸形患者行椎弓根减影截骨术(PSO)和椎弓根减影截骨术的疗效和安全性。
方法:本研究在国际前瞻性系统评价注册中心(PROSPERO)注册。作者对PubMed进行了计算机搜索,EMBASE,WebofScience,科克伦图书馆,中国国家知识基础设施(CNKI),万方数据库,和WeiPu数据库收集关于VCD和PSO治疗AS伴胸腰椎后凸畸形的有效性和安全性的对照临床研究。搜索涵盖了从数据库建立到2023年3月的时期。两名研究人员筛选了文献,提取的数据,并评估了纳入研究的偏倚风险;这些研究人员记录了作者和样本量,他们提取了术中失血的数据,Oswestry残疾指数,脊柱矢状参数,操作时间,和每个研究中的并发症。采用CochraneLibrary提供的RevMan5.4软件进行Meta分析。
结果:本研究共纳入6项队列研究,共342名患者,其中VCD组172例,PSO组170例。VCD组术中出血量低于PSO组(均差[MD]-274.92,95%CI-506.63至-43.20,p=0.02);与PSO组相比,矢状垂直轴的校正显着(MD7.32,95%CI-1.24至15.87,p=0.03),手术时间短于PSO组(MD-80.28,95%CI-150.07至-10.48,p=0.02)。
结论:这项系统综述和荟萃分析显示,VCD在纠正AS伴胸腰椎后凸畸形的矢状失衡方面比PSO更具优势,VCD术中失血较少,更短的操作时间,以及改善生活质量的满意结果。
The goal in this study was to compare the efficacy and safety outcomes of vertebral column decancellation (VCD) and pedicle subtraction osteotomy (PSO) for patients with ankylosing spondylitis (AS) with thoracolumbar kyphotic deformity.
This study was registered on the International Prospective Register of Systematic Reviews (PROSPERO). The authors conducted a computer search of PubMed, EMBASE, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wan Fang Database, and Wei Pu Database to collect controlled clinical studies on the efficacy and safety of VCD and PSO for patients with AS with thoracolumbar kyphotic deformity. The search covered the period from database establishment to March 2023. Two researchers screened the literature, extracted data, and evaluated the risk of bias of the included studies; these researchers recorded the authors and the sample size, and they extracted data on the intraoperative blood loss, Oswestry Disability Index, spine sagittal parameters, operation time, and complications in each study. Meta-analysis was performed using RevMan 5.4 software provided by Cochrane Library.
A total of 6 cohort studies with a total of 342 patients were included in this study, including 172 patients in the VCD group and 170 patients in the PSO group. The VCD group had lower intraoperative blood loss than the PSO group (mean difference [MD] -274.92, 95% CI -506.63 to -43.20, p = 0.02); significant correction of the sagittal vertical axis compared with the PSO group (MD 7.32, 95% CI -1.24 to 15.87, p = 0.03), and the operation time was shorter than that of the PSO group (MD -80.28, 95% CI -150.07 to -10.48, p = 0.02).
This systematic
review and meta-analysis showed that VCD had more advantages than PSO in correcting the sagittal imbalance in the treatment of AS with thoracolumbar kyphotic deformity, and VCD had less intraoperative blood loss, shorter operation time, and satisfactory results in improving the quality of life.