Department of Orthopedic Surgery, Dubrava University Hospital, 10000 Zagreb, Croatia.
Orthop Traumatol Surg Res. 2012 Nov;98(7):795-802. doi: 10.1016/j.otsr.2012.06.014. Epub 2012 Oct 12.
Systematic review was conducted to compare effectiveness and safety of anterior and posterior surgical approach in 3D correction of adolescent idiopathic thoracic scoliosis.
Data sources were MEDLINE and SCOPUS databases. We included studies on the use of either anterior or posterior instrumentation, or their combination, in surgical correction of adolescent idiopathic thoracic scoliosis, with at least 10 enrolled patients, aged less than 20 years at the time of surgery, and a follow-up of at least 24 months. A study was eligible if it reported the number of patients, mean estimate and dispersion of three key outcome measures (frontal and sagittal Cobb angle, apical vertebra rotation according to Perdriolle) at three measurement points (preoperatively, postoperatively, at follow-up). The quality of studies was assessed using the scale by Pilkington.
Although 24 articles met the inclusion criteria, no randomized controlled trials (RCT) was identified. None of the articles was of high quality. Both instrumentations provided a similar degree of reduction of frontal Cobb angle. Long-term effects of surgical correction on the sagittal Cobb angle seemed to be more stable in patients treated by posterior approach, while the anterior approach was more effective in the reduction of apical vertebral rotation. The surgery parameters were more favorable for anterior approach, particularly for the number of fused vertebrae.
Although the available evidence favors neither of the two approaches, our study revealed several important issues: the reports are heterogeneous and provide incomplete relevant information. High quality studies, particularly RCT, are called for.
Level II.
系统评价比较了前路和后路手术在三维矫正青少年特发性胸椎侧凸中的疗效和安全性。
资料来源于 MEDLINE 和 SCOPUS 数据库。我们纳入了使用前路或后路器械，或两者联合治疗青少年特发性胸椎侧凸的研究，至少有 10 例患者，手术时年龄小于 20 岁，随访至少 24 个月。如果研究报告了患者数量、三个关键结局测量指标（额状面和矢状面 Cobb 角、根据 Perdriolle 评估的顶椎旋转）的术前、术后和随访时的均值估计值和离散度，则该研究符合纳入标准。研究质量采用 Pilkington 量表进行评估。
尽管有 24 篇文章符合纳入标准，但未发现随机对照试验（RCT）。没有一篇文章质量很高。两种器械都能提供相似程度的额状面 Cobb 角的降低。后路治疗的患者长期随访时矢状面 Cobb 角的矫正效果似乎更稳定，而前路治疗在减少顶椎旋转方面更有效。手术参数对前路治疗更有利，特别是融合的椎体数量。
尽管现有证据两种方法都不占优势，但我们的研究揭示了几个重要问题：报告存在异质性，提供的相关信息不完整。需要高质量的研究，特别是 RCT。
II 级。
