CAJ | 학술논문

背景：在发展中国家脊柱结核的发病率仍然较高。除了进行药物治疗之外，部分患者需要进行手术治疗，但目前对脊柱结核的治疗途径尚无统一标准。目的：通过查阅与研究脊柱结核前路与后路治疗途径比较的文献，对此两种方式的效果做出系统评价。方法：通过检索Pubmed，Medline，Elseveir，万方，CNKI 等数据库，以“thoracolumbar tuberculosis”，“control ed randomized trial”，“RCT”，“anterior”“posterior”，“脊柱结核”，“前路”，“后路”，“随机对照”等关键词查找相关脊柱结核前后路治疗途径比较的病例对照研究论文，并利用Revman5.1荟萃分析软件对文献中手术时间，术中出血量，Cobb角矫正角度与末次随访丢失角度，植骨融合时间,总住院时间，疗效优良率等数据进行了系统评价。结果与结论：共检索论文1438篇，最后筛选出符合要求的文献9篇；总病例692例，其中前路手术组324例，后路手术组368例。前路手术时间较后路手术时间平均少46.25(40.23，52.26) min，前路手术组出血量较后路手术组出血量平均少148.91(135.12，1625.70) mL，前路手术组Cobb角矫正角度较后路手术组平均小2.40°(2.21°，4.62°)，前路手术组Cobb角丢失角度较后路手术组Cobb角丢失角度平均多0.66°(0.41°，0.91°)，前路手术组较后路手术组总住院时间平均少0.34(-0.32，1.01) d，前路手术组植骨融合时间较后路手术组平均少0.26(0.18，0.34)个月，前路手术组手术效果优良例数较后路手术组多1.18(-0.48，2.85)例；两组手术时间之间手术时间，术中出血量，Cobb角矫正角度与末次随访丢失角度，植骨融合时间之间有显著性差异(P <0.01)，说明脊柱结核前后路方式之间手术时间、术中出血量、Cobb角矫正度数与末次随访丢失角度、植骨融合时间比较有显著区别，但二者总住院时间与手术疗效之间差异无显著性意义。揹景：在髮展中國傢脊柱結覈的髮病率仍然較高。除瞭進行藥物治療之外，部分患者需要進行手術治療，但目前對脊柱結覈的治療途徑尚無統一標準。目的：通過查閱與研究脊柱結覈前路與後路治療途徑比較的文獻，對此兩種方式的效果做齣繫統評價。方法：通過檢索Pubmed，Medline，Elseveir，萬方，CNKI 等數據庫，以“thoracolumbar tuberculosis”，“control ed randomized trial”，“RCT”，“anterior”“posterior”，“脊柱結覈”，“前路”，“後路”，“隨機對照”等關鍵詞查找相關脊柱結覈前後路治療途徑比較的病例對照研究論文，併利用Revman5.1薈萃分析軟件對文獻中手術時間，術中齣血量，Cobb角矯正角度與末次隨訪丟失角度，植骨融閤時間,總住院時間，療效優良率等數據進行瞭繫統評價。結果與結論：共檢索論文1438篇，最後篩選齣符閤要求的文獻9篇；總病例692例，其中前路手術組324例，後路手術組368例。前路手術時間較後路手術時間平均少46.25(40.23，52.26) min，前路手術組齣血量較後路手術組齣血量平均少148.91(135.12，1625.70) mL，前路手術組Cobb角矯正角度較後路手術組平均小2.40°(2.21°，4.62°)，前路手術組Cobb角丟失角度較後路手術組Cobb角丟失角度平均多0.66°(0.41°，0.91°)，前路手術組較後路手術組總住院時間平均少0.34(-0.32，1.01) d，前路手術組植骨融閤時間較後路手術組平均少0.26(0.18，0.34)箇月，前路手術組手術效果優良例數較後路手術組多1.18(-0.48，2.85)例；兩組手術時間之間手術時間，術中齣血量，Cobb角矯正角度與末次隨訪丟失角度，植骨融閤時間之間有顯著性差異(P <0.01)，說明脊柱結覈前後路方式之間手術時間、術中齣血量、Cobb角矯正度數與末次隨訪丟失角度、植骨融閤時間比較有顯著區彆，但二者總住院時間與手術療效之間差異無顯著性意義。
배경：재발전중국가척주결핵적발병솔잉연교고。제료진행약물치료지외，부분환자수요진행수술치료，단목전대척주결핵적치료도경상무통일표준。목적：통과사열여연구척주결핵전로여후로치료도경비교적문헌，대차량충방식적효과주출계통평개。방법：통과검색Pubmed，Medline，Elseveir，만방，CNKI 등수거고，이“thoracolumbar tuberculosis”，“control ed randomized trial”，“RCT”，“anterior”“posterior”，“척주결핵”，“전로”，“후로”，“수궤대조”등관건사사조상관척주결핵전후로치료도경비교적병례대조연구논문，병이용Revman5.1회췌분석연건대문헌중수술시간，술중출혈량，Cobb각교정각도여말차수방주실각도，식골융합시간,총주원시간，료효우량솔등수거진행료계통평개。결과여결론：공검색논문1438편，최후사선출부합요구적문헌9편；총병례692례，기중전로수술조324례，후로수술조368례。전로수술시간교후로수술시간평균소46.25(40.23，52.26) min，전로수술조출혈량교후로수술조출혈량평균소148.91(135.12，1625.70) mL，전로수술조Cobb각교정각도교후로수술조평균소2.40°(2.21°，4.62°)，전로수술조Cobb각주실각도교후로수술조Cobb각주실각도평균다0.66°(0.41°，0.91°)，전로수술조교후로수술조총주원시간평균소0.34(-0.32，1.01) d，전로수술조식골융합시간교후로수술조평균소0.26(0.18，0.34)개월，전로수술조수술효과우량례수교후로수술조다1.18(-0.48，2.85)례；량조수술시간지간수술시간，술중출혈량，Cobb각교정각도여말차수방주실각도，식골융합시간지간유현저성차이(P <0.01)，설명척주결핵전후로방식지간수술시간、술중출혈량、Cobb각교정도수여말차수방주실각도、식골융합시간비교유현저구별，단이자총주원시간여수술료효지간차이무현저성의의。
BACKGROUND:There is a high prevalence of spinal tuberculosis in developing countries. Beside systematic chemotherapy, there are stil some patients who need surgical treatment at certain phase of systematic treatment. However, there is no standard method for surgical treatment of spinal tuberculosis yet. OBJECTIVE:To systematical y evaluate the effect of anterior approach and posterior approach through consulting the literatures on the comparison between anterior approach and posterior approach for the treatment of spinal tuberculosis. METHODS:The PubMed database, Medline database, Elseveir database, Wanfang database and CNKI database were searched with the key words of“thoracolumbar tuberculosis, control ed randomized trial, RCT, anterior, posterior”in Chinese and English. The randomized control ed trials on the comparison between anterior approach and posterior approach for the treatment of spinal tuberculosis were included. The operative time, intraoperative blood loss, correction degree of Cobb angle, loss of Cobb angle at final fol ow-up, al ograft fusion time, total hospital stay and the excellent and good rate of the effectiveness were compared by Revman5.1 software. RESULTS AND CONCLUSION:A total of 1 438 articles were screened out, and final y 9 randomized control ed trials were included. The total number of patients was 692, in which 324 were treated with anterior approach and 368 were treated with posterior approach. The operative time of anterior approach of 46.25(40.23, 52.26) minutes was less than that of posterior approach;the intraoperative blood loss of anterior approach of 148.91(135.12, 1 625.70) mL less than that of posterior approach;the correct degree of Cobb angle of anterior approach of 2.40°(2.21°, 4.62°) was smal er than that of posterior approach;the loss of Cobb angle of anterior approach of 0.66°(0.41°, 0.91°) was larger than that of posterior approach;the total hospital stay of anterior approach of 0.34 (-0.32,1.01) days was less than that of posterior approach;the al ograft fusion time of anterior approach was less than that of posterior approach for 0.26 (0.18, 0.34) months;the number of cases with excellent and good effect of anterior approach was more than that of posterior approach for 1.18(-0.48, 2.85);there were significant differences in operative time, intraoperative blood loss, correct degree of Cobb angle, loss of Cobb angle at final fol ow-up and al ograft fusion time between anterior and posterior approaches (P<0.01). The results showed that there were significant differences in operative time, intraoperative blood loss, correct degree of Cobb angle, loss of Cobb angle at final fol ow-up and al ograft fusion time between anterior and posterior approaches for the treatment of spinal tuberculosis, but there were no significant differences in total hospital stay and surgical efficacy.