Zhu Qicong, Shi Fengchao, Cai Weihua, Bai Jianling, Fan Jin, Yang Huilin
1 Nanjing Medical University, Nanjing, China.
2 Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China.
Int Surg. 2015 Jun;100(6):1124-33. doi: 10.9738/INTSURG-D-14-00135.1.
Despite extensive research on thoracolumbar fractures, controversy still exists about which approach is the most appropriate. Lack of evidence-based practice may result in patients being treated inappropriately. The objective of study was to perform a systematic review of the effectiveness of the anterior and posterior approaches in the treatment of thoracolumbar fractures. We conducted searches of PubMed and the Cochrane Library, searching for relevant trials up to August 2013 that compared anterior and posterior for the treatment of thoracolumbar fractures. The key words "anterior," "posterior," "thoracolumbar fracture," "CCT," and "RCT" were used. We assessed all included literature by using the Cochrane handbook (version 5.1). The results were expressed as the mean difference for continuous outcomes and risk difference for dichotomous outcomes, with a 95% confidence interval, using RevMan version 5.2. There were 3 randomized controlled trials and 11 clinical controlled trials included. The meta-analysis showed no significant difference between groups regarding Cobb angle, the Frankel scale, ASIA/JOA motor score, complications, and number of patients returning to work. Compared with the anterior approach, the posterior approach demonstrated superior canal decompression. In the burst fracture subgroup, operative times were significantly shorter and perioperative blood loss was less in the posterior approach group. The posterior approach is more effective for canal decompression, operative times, and perioperative blood loss. However, because of the lack of randomized controlled trials, and because of large sample size studies, heterogeneity was significant between reports. The optimal treatment for thoracolumbar fractures requires further study.
尽管对胸腰椎骨折进行了广泛研究，但对于哪种治疗方法最为合适仍存在争议。缺乏循证医学实践可能导致患者接受不恰当的治疗。本研究的目的是对前路和后路治疗胸腰椎骨折的有效性进行系统评价。我们检索了PubMed和Cochrane图书馆，查找截至2013年8月比较前路和后路治疗胸腰椎骨折的相关试验。使用了关键词“前路”“后路”“胸腰椎骨折”“CCT”和“RCT”。我们使用Cochrane手册（第5.1版）对所有纳入文献进行评估。结果以连续变量结果的均值差和二分变量结果的风险差表示，并给出95%置信区间，采用RevMan 5.2版软件。共纳入3项随机对照试验和11项临床对照试验。荟萃分析显示，两组在Cobb角、Frankel分级、ASIA/JOA运动评分、并发症以及恢复工作的患者数量方面无显著差异。与前路手术相比，后路手术在椎管减压方面表现更优。在爆裂骨折亚组中，后路手术组的手术时间显著更短，围手术期失血量更少。后路手术在椎管减压、手术时间和围手术期失血量方面更有效。然而，由于缺乏随机对照试验，且因研究样本量较大，各报告之间存在显著的异质性。胸腰椎骨折的最佳治疗方法仍需进一步研究。
