后路融合与不融合结合短节段椎弓根钉内固定 治疗胸腰段脊柱爆裂骨折的系统评价
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作者Author单位AddressE-Mail
李想 LI Xiang 中国医学科学院 北京协和医学院 北京协和医院骨科,北京 100730 Department of Orthopaedics,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College,Beijing 100730,China  
王以朋 WANG Yi-peng 中国医学科学院 北京协和医学院 北京协和医院骨科,北京 100730 Department of Orthopaedics,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College,Beijing 100730,China ypwang@medmail.com.cn 
邱贵兴 QIU Gui-xing 中国医学科学院 北京协和医学院 北京协和医院骨科,北京 100730 Department of Orthopaedics,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College,Beijing 100730,China  
赵宇 ZHAO Yu 中国医学科学院 北京协和医学院 北京协和医院骨科,北京 100730 Department of Orthopaedics,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College,Beijing 100730,China  
期刊信息:《中国骨伤》2011年,第24卷,第1期,第5-10页
DOI:10.3969/j.issn.1003-0034.2011.01.002
基金项目:
中文摘要:

目的:对后路短节段椎弓根内固定结合或不结合植骨融合治疗成人胸腰段爆裂骨折的疗效进行系统评价。

方法:计算机检索MEDLINE(1966.1-2010.9 )、EMBASE(1966.1-2010.9)、中国生物医学数据库(1979.1-2010.7),手工检索中文相关杂志。收集所有采用后路短节短椎弓根钉内固定治疗胸腰段(T10-L2)爆裂骨折,并对比术中行后外侧植骨融合与不行植骨融合临床疗效的所有随机对照、半随机对照、前瞻性以及回顾性临床队列研究的文献,并评价纳入研究的方法学质量。利用Cochrane协作网最新提供的RevMan 5.0.18软件进行统计学分析。

结果:共纳入符合标准的文献4篇,其中随机对照研究2篇;前瞻性队列研究1篇;回顾性队列研究1篇。Meta分析显示,非融合组在手术时间、术中出血量方面明显低于融合组;非融合组与融合组在维持后凸矫正度数、神经功能恢复以及腰痛方面无统计学差异;非融合组内固定失败率明显高于融合组。

结论:对于胸腰段爆裂骨折的患者,后路短节段椎弓根钉内固定不结合后外侧植骨融合可增加内固定失败的发生率。考虑目前的医疗环境,建议在使用后路短节段椎弓根钉内固定治疗胸腰段爆裂骨折时采取植骨融合技术。
【关键词】脊柱骨折  脊柱融合术  外科手术  计算机系统
 
Systematic review of posterior short-segment pedicle screws fixation with or without fusion for thoracolumbar burst fractures
ABSTRACT  

Objective: To evaluate the effectiveness of posterior short-segment pedicle screws fixation with or without fusion for thoracolumbar burst fractures.

Methods: Randomized controlled trails(RCTs),prospective and retrospective clinical controlled trails related to application posterior short-segment pedicle screws fixation with or without fusion for thoracolumbar burst fractures were searched from Pubmed(1966.1-2010.9 ),EMBASE(1966.1-2010.9 ) and CNKI (1966.1-2010.9 ). Related Chinese journals were hand-searched. RevMan 5.0.18 provided by Cochrane was used to analyzing the data.

Results: Two RCTs,one prospective clinical controlled trails and one retrospective clinical controlled trails were included. The combined results showed that both operative time and blood loss were significantly less in the nonfusion group compared with fusion group. There were no significant difference in correction of kyphosis,neurological function improvement and back pain. Nonfusion group has significantly high risk of internal fixation failure.

Conclusion: For patients with thoracolumbar burst fractures,posterior short-segment pedicle screws fixation without fusion can increase the risk of implant failure. Given the present medical condition,the bone-graft fusion is necessary when thoracolumbar burst fracture is treated with posterior short-segment pedicle screws fixation.
KEY WORDS  Spinal fracture  Spinal fusion  Surgical procedures,operative  Computer systems
 
引用本文,请按以下格式著录参考文献:
中文格式:李想,王以朋,邱贵兴,赵宇.后路融合与不融合结合短节段椎弓根钉内固定 治疗胸腰段脊柱爆裂骨折的系统评价[J].中国骨伤,2011,24(1):5~10
英文格式:LI Xiang,WANG Yi-peng,QIU Gui-xing,ZHAO Yu.Systematic review of posterior short-segment pedicle screws fixation with or without fusion for thoracolumbar burst fractures[J].zhongguo gu shang / China J Orthop Trauma ,2011,24(1):5~10
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