Sun Xiang-Yao, Zhang Xi-Nuo, Hai Yong
Department of Orthopedics, Beijing Chaoyang Hospital, China Capital Medical University, Beijing, 100020, China.
Eur Spine J. 2017 May;26(5):1418-1431. doi: 10.1007/s00586-016-4818-4. Epub 2016 Oct 18.
This study evaluated differences in outcome variables between percutaneous, traditional, and paraspinal posterior open approaches for traumatic thoracolumbar fractures without neurologic deficit.
A systematic review of PubMed, Cochrane, and Embase was performed. In this meta-analysis, we conducted online searches of PubMed, Cochrane, Embase using the search terms "thoracolumbar fractures", "lumbar fractures", ''percutaneous'', "minimally invasive", ''open", "traditional", "posterior", "conventional", "pedicle screw", "sextant", and "clinical trial". The analysis was performed on individual patient data from all the studies that met the selection criteria. Clinical outcomes were expressed as risk difference for dichotomous outcomes and mean difference for continuous outcomes with 95 % confidence interval. Heterogeneity was assessed using the χ test and I statistics.
There were 4 randomized controlled trials and 14 observational articles included in this analysis. Percutaneous approach was associated with better ODI score, less Cobb angle correction, less Cobb angle correction loss, less postoperative VBA correction, and lower infection rate compared with open approach. Percutaneous approach was also associated with shorter operative duration, longer intraoperative fluoroscopy, less postoperative VAS, and postoperative VBH% in comparison with traditional open approach. No significant difference was found in Cobb angle correction, postoperative VBA, VBA correction loss, Postoperative VBH%, VBH correction loss, and pedicle screw misplacement between percutaneous approach and open approach. There was no significant difference in operative duration, intraoperative fluoroscopy, postoperative VAS, and postoperative VBH% between percutaneous approach and paraspianl approach.
The functional and the radiological outcome of percutaneous approach would be better than open approach in the long term. Although trans-muscular spatium approach belonged to open fixation methods, it was strictly defined as less invasive approach, which provided less injury to the paraspinal muscles and better reposition effect.
本研究评估了经皮、传统和椎旁后外侧开放入路治疗无神经功能缺损的创伤性胸腰椎骨折的结局变量差异。
对PubMed、Cochrane和Embase进行系统评价。在这项荟萃分析中，我们使用搜索词“胸腰椎骨折”、“腰椎骨折”、“经皮”、“微创”、“开放”、“传统”、“后路”、“常规”、“椎弓根螺钉”、“六分仪”和“临床试验”在PubMed、Cochrane、Embase上进行在线搜索。对所有符合入选标准的研究的个体患者数据进行分析。临床结局以二分结局的风险差和连续结局的均数差表示，并给出95%置信区间。使用χ检验和I统计量评估异质性。
本分析纳入了4项随机对照试验和14篇观察性文章。与开放入路相比，经皮入路与更好的ODI评分、更小的Cobb角矫正、更小的Cobb角矫正丢失、更少的术后椎体前后缘高度矫正以及更低的感染率相关。与传统开放入路相比，经皮入路还与更短的手术时间、更长的术中透视时间、更少的术后视觉模拟评分（VAS）以及术后椎体后凸百分比相关。经皮入路与开放入路在Cobb角矫正、术后椎体前后缘高度、椎体前后缘高度矫正丢失、术后椎体后凸百分比、椎体后凸矫正丢失以及椎弓根螺钉置入错误方面无显著差异。经皮入路与椎旁入路在手术时间、术中透视时间、术后VAS以及术后椎体后凸百分比方面无显著差异。
从长期来看，经皮入路的功能和影像学结局优于开放入路。虽然经肌间隙入路属于开放固定方法，但严格定义为微创入路，对椎旁肌肉的损伤较小且复位效果较好。
