CAJ | 학술논문

背景：临床上胸腰椎骨折越来越多，但对于胸腰椎骨折固定方式存在较多争论，对于采用经伤椎置钉椎弓根螺钉固定还是传统跨节段椎弓根螺钉固定存在不同观点，尚缺乏循证医学支持。目的：对经伤椎置钉与跨节段椎弓根螺钉固定治疗胸腰椎骨折固定后效果效果的评价。方法：按照 Cochrane 系统评价的方法，检索下列数据库：美国国立医学图书馆数据库、中国知网、万方数数据库，维普数据库并手工检索等方法收集会议文献，检索时间为2005年至2015年3月。收集所有随机对照试验，采用Cochrane协作网提供的软件Revman 4.2进行Meta分析。结果与结论：通过筛选，总共纳入14个临床对照试验共个956例患者。Meta分析结果显示，伤椎置钉组较跨节段组治疗胸腰椎骨折固定后Cobb角度改善明显(OR=-2.72，95%CI：-3.08至-2.35，P <0.01)。经伤椎置钉组较跨节段组椎体高度矫正率较高(OR=7.45，95%CI：6.94-7.97，P <0.01)。经伤椎置钉组较跨节段组相比较内固定失败率较低(OR=0.12，95%CI：0.05-0.27，P <0.01)。结果证实，经伤椎置钉与跨节段椎弓根螺钉固定治疗胸腰椎骨折相比较固定后 Cobb 角度改善明显，固定后椎体高度纠正明显以及引起内固定失败率等并发症更少，固定效果较好。
배경：림상상흉요추골절월래월다，단대우흉요추골절고정방식존재교다쟁론，대우채용경상추치정추궁근라정고정환시전통과절단추궁근라정고정존재불동관점，상결핍순증의학지지。목적：대경상추치정여과절단추궁근라정고정치료흉요추골절고정후효과효과적평개。방법：안조 Cochrane 계통평개적방법，검색하렬수거고：미국국립의학도서관수거고、중국지망、만방수수거고，유보수거고병수공검색등방법수집회의문헌，검색시간위2005년지2015년3월。수집소유수궤대조시험，채용Cochrane협작망제공적연건Revman 4.2진행Meta분석。결과여결론：통과사선，총공납입14개림상대조시험공개956례환자。Meta분석결과현시，상추치정조교과절단조치료흉요추골절고정후Cobb각도개선명현(OR=-2.72，95%CI：-3.08지-2.35，P <0.01)。경상추치정조교과절단조추체고도교정솔교고(OR=7.45，95%CI：6.94-7.97，P <0.01)。경상추치정조교과절단조상비교내고정실패솔교저(OR=0.12，95%CI：0.05-0.27，P <0.01)。결과증실，경상추치정여과절단추궁근라정고정치료흉요추골절상비교고정후 Cobb 각도개선명현，고정후추체고도규정명현이급인기내고정실패솔등병발증경소，고정효과교호。
BACKGROUND:Thoracolumbar fracture becomes more in the clinic. The fixation manner of thoracolumbar fracture is controversial. Injured vertebra pedicle screw fixation or traditional cross-segment pedicle screw fixation are controversial and lack the support of evidence-based medicine. OBJECTIVE: To evaluate the outcomes of injured vertebra pedicle screw and cross-segment pedicle screw fixation for thoracolumbar fractures. METHODS: According to Cochrane system evaluation, the folowing databases were retrieved: National Library of Medicine database, China National Knowledge Infrastructure, Wanfang database and VIP database. Conference proceedings were searched by hand. The retrieval time ranged from 2005 to March 2015. Randomized controled trials were colected. Meta-analysis was performed by using Cochrane Colaboration Revman 4.2. RESULTS AND CONCLUSION: By screening, a total of 14 clinical controled trials were selected, including 956 patients. Meta-analysis results showed that postoperative Cobb angle was improved significantly in the vertebral pedicle screw group than in the cross-segment pedicle screw fixation group (OR=-2.72, 95%CI:-3.08--2.35,P < 0.01). Correction rate of the vertebral height was higher in the vertebral pedicle screw group than in the cross-segment pedicle screw fixation group (OR=7.45, 95%CI:6.94-7.97,P < 0.01). The failure rate was lower in the vertebral pedicle screw group than in the cross-segment pedicle screw fixation group (OR=0.12, 95%CI: 0.05- 0.27,P < 0.01). Results verify that postoperative Cobb angle improved significantly after the injured vertebrae pedicle screw and cross-segment pedicle screw fixation for thoracolumbar fractures. The height was obviously corrected and fewer complications were caused such as implant failure. The fixation effect was good.