背景:胸腰椎骨折具有急性起病的特点,快速变化,和严重的创伤。治疗胸腰椎骨折的最佳方法是通过骨折复位手术。手术方法包括经皮椎弓根螺钉,后路经皮椎弓根螺钉内固定,和开放式椎弓根螺钉内固定。
方法:我们搜索了PubMed,Embase,和Medline英语数据库从1991年4月到2021年4月,关键字包括“经皮平板电脑屏幕”,“后路经皮平板屏幕固定术”,\"打开平板电脑屏幕固定\",“胸椎骨折”,“胸椎骨折”,“胸廓”,和“血管骨折”。使用Cochrane提供的RevMan5.3进行荟萃分析。
结果:本研究共纳入9篇。采用经皮椎弓根螺钉内固定和后路经皮椎弓根螺钉内固定作为手术方法,将患者分为实验组和对照组。以开放椎弓根螺钉内固定为对照组。手术时间的平均差(MD),失血,疼痛评分,术后并发症,螺杆碎片率,住院时间分别为-0.73,-192.16,-0.70,1.49,0.32和-1.26;95%置信区间(CI)为(-0.94,-0.51),(-213.23,-171.09),(-0.82,-0.57),(0.47,4.79),(0.10,0.99),和(-1.82,-0.71),Z值分别为6.71、17.87、10.95、0.67、1.97和4.46;P值分别为<0.00001、<0.00001、<0.00001、0.50、0.05和<0.00001。
结论:本次荟萃分析共纳入9篇文献。与开放手术相比,使用经皮椎弓根螺钉和后路经皮椎弓根螺钉固定术的失血量较少,更短的操作时间,住院时间缩短,更少的痛苦,以及较低的螺钉脱位和术后感染率,表明使用经皮椎弓根螺钉和后路经皮椎弓根螺钉固定比开放手术更有效。
BACKGROUND: Thoracolumbar fractures have the characteristics of acute onset, rapid change, and severe trauma. The best way to treat thoracolumbar fractures is through fracture reduction surgery. The surgical methods include percutaneous pedicle screw, posterior percutaneous pedicle screw internal fixation, and open pedicle screw internal fixation.
METHODS: We searched the PubMed, Embase, and Medline English database from April 1991 to April 2021, and the keywords included \"percutaneous tablet screen\", \"posterior percutaneous tablet screen fixation\", \"open tablet screen fixation\", \"fracture of thoracic vertebrae\", \"thoracic fractures\", \"thoracic\", and \"vascular fracture\". RevMan5.3 provided by Cochrane was used for meta-analysis.
RESULTS: A total of 9 articles were included in this study. Percutaneous pedicle screw fixation and posterior percutaneous pedicle screw fixation were adopted as the surgical methods, and patients were enrolled into experimental and control groups. Open pedicle screw internal fixation was set as the control group. The mean difference (MD) of operation time, blood loss, pain score, postoperative complications, screw debris rate, and hospital stay were -0.73, -192.16, -0.70, 1.49, 0.32, and -1.26, respectively; 95% confidence intervals (CIs) were (-0.94, -0.51), (-213.23, -171.09), (-0.82, -0.57), (0.47, 4.79), (0.10, 0.99), and (-1.82, -0.71), respectively; Z values were 6.71, 17.87, 10.95, 0.67, 1.97, and 4.46, respectively; and P values were <0.00001, <0.00001, <0.00001, 0.50, 0.05, and <0.00001, respectively.
CONCLUSIONS: A total of 9 articles were included in this meta-analysis. Compared with open surgery, the use of percutaneous pedicle screw and posterior percutaneous pedicle screw fixation had less blood loss, shorter operation time, shorter hospital stay, less pain, as well as lower screw dislocation and postoperative infection rates, indicating that the use of percutaneous pedicle screw and posterior percutaneous pedicle screw fixation is more effective than open surgery.