Yu Dandan, Zhang Yuxuan, Li Xia, Wang Wei, Li Zengming, Xiao Jun
Guangzhou Special Service Recuperation Center of PLA Rocket Force, Guangzhou, Guangdong, People's Republic of China.
Medicine (Baltimore). 2025 Jun 6;104(23):e42699. doi: 10.1097/MD.0000000000042699.
To evaluate the effectiveness and safety of fixation levels with pedicle screw fixation for thoracolumbar burst fractures (TLBF).
A systematic and comprehensive literature search was performed from inception to May 2024 in both English and Chinese databases, involving Medline, Cochrane Library, Embase, China National Knowledge Infrastructure Database, Wanfang Database, Chongqing VIP information, and SinoMed. Clinical trials of short-segment fixation and long-segment fixation (LSF) in the treatment of thoracolumbar burst fractures were included. Quality of included trials were assessed according to the methodological index for non-randomized studies (MINORS). Data analysis was conducted by using Review Manager 5.4 software and Stata. The quality of evidence in this systematic review was evaluated using the GRADE evidence quality evaluation system.
Seventeen eligible trials with a total of 1031 patients were included in this meta-analysis. Meta-analysis revealed that intraoperative bleeding (MD = -36.64, 95% CI = -56.36 to -16.92, Z = 3.64, P = .0003) and operation time (MD = -25.73, 95% CI = -46.56 to -4.90, Z = 2.42, P = .02) in the LSF group were higher than those in the short-segment fixation group. There were no significant differences in terms of the final follow-up sagittal index (MD = 1.64, 95% CI = -0.75 to 4.03, Z = 1.35, P = .18) and the final follow-up Oswestry disability index (MD = -2.94, 95% CI = -9.74 to 3.85, Z = 0.85, P = .40) between the 2 groups. The LSF group had the advantages of better the final follow-up Cobb angle (MD = 2.52, 95% CI = 0.35-4.70, Z = 2.27, P = .02), the final follow-up visual analog scale (MD = 0.09, 95% CI = 0.04-0.14, Z = 3.59, P = .0003) and lower the final follow-up implant failure (MD = 3.43, 95% CI = 1.78-6.62, Z = 3.69, P = .0002). The funnel plots and Egger test showed some evidence of asymmetry, suggesting publication bias or small sample effect was existed.
For thoracolumbar burst fractures, LSF can better improve patients' low back pain and better maintain postoperative orthopedic effect.
评估椎弓根螺钉固定治疗胸腰椎爆裂骨折（TLBF）时固定节段的有效性和安全性。
从数据库建库至2024年5月，在英文和中文数据库（包括Medline、Cochrane图书馆、Embase、中国知网数据库、万方数据库、重庆维普资讯和中国生物医学文献数据库）中进行系统全面的文献检索。纳入胸腰椎爆裂骨折治疗中短节段固定与长节段固定（LSF）的临床试验。根据非随机研究的方法学指标（MINORS）评估纳入试验的质量。使用Review Manager 5.4软件和Stata进行数据分析。采用GRADE证据质量评估系统评估本系统评价中的证据质量。
本荟萃分析纳入了17项符合条件的试验，共1031例患者。荟萃分析显示，LSF组的术中出血量（MD = -36.64，95%CI = -56.36至-16.92，Z = 3.64，P = .0003）和手术时间（MD = -25.73，95%CI = -46.56至-4.90，Z = 2.42，P = .02）高于短节段固定组。两组在末次随访矢状面指数（MD = 1.64，95%CI = -0.75至4.03，Z = 1.35，P = .18）和末次随访Oswestry功能障碍指数（MD = -2.94，95%CI = -9.74至3.85，Z = 0.85，P = .40）方面无显著差异。LSF组在末次随访Cobb角（MD = 2.52，95%CI = 0.35 - 4.70，Z = 2.27，P = .02）、末次随访视觉模拟评分（MD = 0.09，95%CI = 0.04 - 0.14，Z = 3.59，P = .0003）方面具有优势，且末次随访内固定失败率较低（MD = 3.43，95%CI = 1.78 - 6.62，Z = 3.69，P = .0002）。漏斗图和Egger检验显示存在一定的不对称性证据，提示可能存在发表偏倚或小样本效应。
对于胸腰椎爆裂骨折，长节段固定能更好地改善患者腰痛，并更好地维持术后矫形效果。
