Smits Arjen Johannes, Polack Meaghan, Deunk Jaap, Bloemers Frank Willem
Department of Trauma Surgery, VU University Medical Centre, Amsterdam, The Netherlands.
J Craniovertebr Junction Spine. 2017 Jul-Sep;8(3):168-178. doi: 10.4103/jcvjs.JCVJS_8_17.
Systematic review with meta-analysis.
Additional anterior stabilization might prevent posterior implant failure, but over time, the disadvantageous of bone grafts have become evident. The objective of this systematic review was to compare risks and advantages of additional anterior stabilization with a titanium cage to solely posterior fixation for traumatic thoracolumbar fractures.
An electronic search was performed in the literature from 1980 to March 2016. Studies comparing only posterior with anteroposterior fixation by means of a titanium cage were included in this study. Data extraction and Cochrane risk of bias assessment were done by two independent authors. In addition, the PRISMA statement was followed, and the GRADE approach was used to present results.
Of the 1584 studies, two randomized controlled trials (RCTs) and one retrospective cohort study were included in the meta-analysis. The RCTs reported evidence of high quality that anteroposterior stabilization maintained better kyphosis correction than posterior stabilization alone. However, these results were neutralized in the meta-analysis by the cohort study. Implant failure was reported by one study, in the posterior group. No differences in follow-up visual analog scale scores, neurologic improvement, and complications were found. Operation time, blood loss, and hospital stay all increased in the anteroposterior group.
Patients with a highly comminuted or unstable fracture could benefit from combined anteroposterior stabilization with a titanium cage, for some evidence suggests this prevents loss of correction. However, large randomized studies still lack. There is a risk of cage subsidence, and increased perioperative risks have to be considered when choosing the optimal treatment.
系统评价与荟萃分析。
额外的前路稳定术可能预防后路植入物失败，但随着时间推移，骨移植的弊端已变得明显。本系统评价的目的是比较使用钛笼进行额外前路稳定术与单纯后路固定治疗创伤性胸腰椎骨折的风险和优势。
对1980年至2016年3月的文献进行电子检索。本研究纳入了仅比较后路与前路钛笼固定的研究。由两名独立作者进行数据提取和Cochrane偏倚风险评估。此外，遵循PRISMA声明，并采用GRADE方法呈现结果。
在1584项研究中，两项随机对照试验（RCT）和一项回顾性队列研究纳入了荟萃分析。RCT报告了高质量证据，表明前路稳定术比单纯后路稳定术能更好地维持后凸畸形矫正。然而，这些结果在荟萃分析中被队列研究中和。一项研究报告了后路组的植入物失败情况。在随访视觉模拟量表评分、神经功能改善和并发症方面未发现差异。前路组的手术时间、失血量和住院时间均增加。
对于高度粉碎性或不稳定骨折的患者，联合前路钛笼稳定术可能有益，因为一些证据表明这可防止矫正丢失。然而，仍缺乏大型随机研究。存在钛笼下沉的风险，在选择最佳治疗方法时必须考虑围手术期风险增加的问题。
