Anterior versus posterior approach for treatment of thoracolumbar burst fractures: a meta-analysis
Anterior versus posterior approach for treatment of thoracolumbar burst fractures: a meta-analysis
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DOI：
10.1007/s00586-013-2987-y
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发表时间：
2013-09
影响因子：
2.8
通讯作者：
Gui-jun Xu;Zhi Li;Jian-xiong Ma;Tao Zhang;Xin Fu;Xin-long Ma
中科院分区：
文献类型：
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作者：
Gui-jun Xu;Zhi Li;Jian-xiong Ma;Tao Zhang;Xin Fu;Xin-long Ma
目的批判性地回顾和总结比较前路手术和后路手术治疗胸腰椎爆裂性骨折的文献，以确定更好的方法。方法在这项荟萃分析中，我们使用搜索词“胸腰椎骨折”、“前路”、“后路”、“对照临床试验”对MEDLINE、EMBASE、Cochrane 对照试验中心注册库和其他数据库进行电子检索。还手动检索相关期刊或会议论文集。数据提取和质量评估符合 Cochrane 协作指南。对来自符合选择标准的所有试验的个体患者数据进行分析。当存在显着异质性时进行敏感性分析。结果表示为二分结果的风险差异和具有 95% 置信区间的连续结果的平均差异。 结果 检索了 4 项随机临床试验和 3 项对照临床试验，比较了前路与后路入路治疗胸腰椎爆裂性骨折的结果；这些研究分别包括前路组和后路组的 179 名患者和 152 名患者。两组在神经功能恢复、重返工作岗位、并发症和科布角方面没有差异。前路手术比后路手术时间更长、失血量更大、费用更高。结论后路手术可能比前路手术更有效。然而，需要更多高质量的随机对照试验来比较这些方法并指导临床决策。证据级别II级，治疗研究。有关证据级别的完整描述，请参阅作者指南。
PurposeTo critically review and summarize the literature comparing the results of surgery via an anterior approach and that via a posterior approach for the treatment of thoracolumbar burst fractures to identify the better approach.MethodsIn this meta-analysis, we conducted electronic searches of MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and other databases using the search terms “thoracolumbar fractures”, “anterior”, “posterior”, “controlled clinical trials”. Relevant journals or conference proceedings were also searched manually. Data extraction and quality assessment were in accordance with Cochrane Collaboration guidelines. The analysis was performed on individual patient data from all the trials that met the selection criteria. Sensitivity analysis was performed when there was significant heterogeneity. Results were expressed as risk difference for dichotomous outcomes and mean difference for continuous outcomes with 95 % confidence interval.ResultsFour randomized clinical trials and three controlled clinical trials comparing the results of the anterior versus posterior approach in the treatment of thoracolumbar burst fractures were retrieved; these studies included 179 and 152 patients in the anterior and posterior approach groups, respectively. There were no differences in terms of neurological recovery, return to work, complications and Cobb angle between the two groups. The anterior approach was associated with longer operative time, greater blood loss and higher cost than the posterior approach.ConclusionsThe posterior approach may be more effective than the anterior approach. However, more high-quality, randomized controlled trials are required to compare these approaches and guide clinical decision-making.Level of EvidenceLevel II, therapeutic study. See the Guidelines for Authors for a complete description of level of evidence.