Smith-Petersen截骨术与经椎弓根截骨术治疗强直性脊柱炎胸腰椎后凸畸形的比较：一项系统评价与Meta分析
Comparison of Smith-Petersen osteotomy and pedicle subtraction osteotomy for the correction of thoracolumbar kyphotic deformity in ankylosing spondylitis: a systematic review and meta-analysis.
作者信息
Liu Hui, Yang Changsheng, Zheng Zhaomin, Ding Wenbin, Wang Jianru, Wang Hua, Li Sibei
机构信息
From the Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
出版信息
Spine (Phila Pa 1976). 2015 Apr 15;40(8):570-9. doi: 10.1097/BRS.0000000000000815.
STUDY DESIGN
A systematic review and meta-analysis.
OBJECTIVE
To compare the efficacy and safety outcomes of Smith-Petersen osteotomy (SPO) and pedicle subtraction osteotomy (PSO) for patients with ankylosing spondylitis (AS) with thoracolumbar kyphotic deformity.
SUMMARY OF BACKGROUND DATA
Both SPO and PSO are used to correct thoracolumbar kyphotic deformity due to AS. Evidence is insufficient to determine which has better efficacy and safety outcomes.
METHODS
A systematic literature search was performed. Studies concentrating on treating thoracolumbar kyphotic deformity due to AS with SPO and/or PSO were included. Efficacy was determined with radiographical outcomes, including sagittal vertical axis and lumbar lordosis. Safety was determined with complication rates. The data were analyzed with Review Manager and R software.
RESULTS
Twenty-three studies were included. Among them, 5 were comparative studies and were used for a meta-analysis. All 23 studies were pooled to evaluate the radiographical correction and incidence of complications. The meta-analysis of the 5 comparative studies showed no significant difference between groups in either correction of sagittal vertical axis and lumbar lordosis or incidence of complications. The pooled data also showed similar radiological correction and complication rates between SPO and PSO. SPO was found to have potential risk of aortic rupture and slightly higher risk of permanent neurological deficit without statistical significance, whereas PSO was shown longer operative time and more blood loss.
CONCLUSION
This systematic review and meta-analysis demonstrates that both SPO and PSO are effective in correcting thoracolumbar kyphotic deformity in AS and have similar risk of most complications. Aortic rupture and related death during correction is reported in SPO and should be taken into consideration for decision making.
LEVEL OF EVIDENCE
研究设计
系统评价与荟萃分析。
目的
比较史密斯-彼得森截骨术（SPO）和经椎弓根椎体截骨术（PSO）治疗强直性脊柱炎（AS）合并胸腰椎后凸畸形患者的疗效和安全性。
背景数据总结
SPO和PSO均用于矫正AS所致的胸腰椎后凸畸形。证据不足，无法确定哪种方法具有更好的疗效和安全性。
方法
进行系统的文献检索。纳入专注于用SPO和/或PSO治疗AS所致胸腰椎后凸畸形的研究。通过影像学结果确定疗效，包括矢状垂直轴和腰椎前凸。通过并发症发生率确定安全性。使用Review Manager和R软件分析数据。
结果
纳入23项研究。其中，5项为比较研究，用于荟萃分析。所有23项研究汇总以评估影像学矫正和并发症发生率。5项比较研究的荟萃分析显示，两组在矢状垂直轴和腰椎前凸矫正或并发症发生率方面均无显著差异。汇总数据还显示，SPO和PSO之间的影像学矫正和并发症发生率相似。发现SPO有主动脉破裂的潜在风险，永久性神经功能缺损风险略高，但无统计学意义，而PSO手术时间更长，失血更多。
结论
本系统评价和荟萃分析表明，SPO和PSO在矫正AS胸腰椎后凸畸形方面均有效，且大多数并发症风险相似。SPO报告了矫正过程中的主动脉破裂及相关死亡，决策时应予以考虑。
证据级别
4级。
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