Department of Spine Surgery, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China.
Eur Rev Med Pharmacol Sci. 2018 Jul;22(1 Suppl):45-52. doi: 10.26355/eurrev_201807_15362.
Minimal and open pedicle screw fixation procedures have been widely used in the treatment of thoracolumbar fractures. However, the efficacy and safety of these approaches remain unclear. This meta-analysis was conducted to evaluate perioperative, functional and radiological outcomes of percutaneous versus open pedicle screw fixation for thoracolumbar fractures.
To obtain relevant literature, a systematic search was performed using the MEDLINE, EMBASE, and Cochrane databases. The Cowley criteria were used to evaluate the risk of bias for the included studies. A database that included patient demographic information and perioperative outcomes was established. Summary odds ratios (ORs) and weighted mean differences (WMDs) with 95% confidence intervals (CIs) were estimated. Analyses were performed for the two subgroups of Chinese studies and studies from other nations. Publication bias was assessed using the funnel plot method.
Eleven comparative observational studies that satisfied our inclusion criteria were identified via a literature search in the MEDLINE, EMBASE, and Cochrane databases. Relative to the open approach, the minimal approach was associated with less blood loss (WMD=-218.10, 95% CI: -266.31 to -169.88, p<0.00001) and shorter operative time (WMD=-15.31, 95% CI: -24.73 to -5.88, p=0.001). Evidence indicated that a significant difference was observed between Chinese studies and other studies with respect to blood loss (p=0.02). We also found that the minimal approach was associated with a lower postoperative visual analog scale (VAS) score (WMD = -1.06, 95% CI: -1.32 to -0.8, p<0.00001) and less correction loss (WMD=-0.59, 95% CI: -1.16 to 0.02, p=0.04) than the traditional open approach. No significant difference between these approaches was found with respect to complication rate (OR 0.78, 95% CI: 0.39 to 1.55, p=0.48).
The evidence indicated that the minimal approach had better functional and radiological outcomes than the open approach. Neither approach was superior with respect to complication rate. Relative to the open approach, the minimal approach might be associated with decreased operative time, less blood loss and a shorter hospital stay.
微创经皮椎弓根螺钉固定术已广泛应用于胸腰椎骨折的治疗。然而，这些方法的疗效和安全性仍不清楚。本荟萃分析旨在评估经皮与开放椎弓根螺钉固定治疗胸腰椎骨折的围手术期、功能和影像学结果。
为了获得相关文献，系统检索了 MEDLINE、EMBASE 和 Cochrane 数据库。采用 Cowley 标准评估纳入研究的偏倚风险。建立了包含患者人口统计学信息和围手术期结果的数据库。使用 95%置信区间（CI）估计汇总优势比（OR）和加权均数差（WMD）。对来自中国的研究和其他国家的研究这两个亚组进行了分析。使用漏斗图法评估发表偏倚。
通过对 MEDLINE、EMBASE 和 Cochrane 数据库的文献检索，共确定了 11 项符合纳入标准的对照观察性研究。与开放入路相比，微创入路的出血量更少（WMD=-218.10，95%CI：-266.31 至-169.88，p<0.00001），手术时间更短（WMD=-15.31，95%CI：-24.73 至-5.88，p=0.001）。证据表明，在出血量方面，中国研究与其他研究之间存在显著差异（p=0.02）。我们还发现，微创入路的术后视觉模拟评分（VAS）（WMD = -1.06，95%CI：-1.32 至-0.8，p<0.00001）和矫正丢失更少（WMD=-0.59，95%CI：-1.16 至 0.02，p=0.04）与传统开放入路相比。两种方法在并发症发生率方面无显著差异（OR 0.78，95%CI：0.39 至 1.55，p=0.48）。
证据表明微创入路的功能和影像学结果优于开放入路。两种方法在并发症发生率方面均无优势。与开放入路相比，微创入路可能具有手术时间短、出血量少、住院时间短的优点。
