经皮微创与开放椎弓根螺钉内固定术治疗单纯性胸腰椎骨折的Meta分析

目的 通过经皮微创(PPSF)与开放椎弓根螺钉内固定术(OPSF)治疗单纯性胸腰椎骨折的临床疗效的Meta分析，系统评价其治疗胸腰椎骨折的安全性及临床疗效。方法 利用计算机进行文献检索，主要检索的文献数据库包括:中国知网全文数据库、万方数据库、PubMed、医院知识总库等，文献检索完成后，根据纳入标准纳入关于经皮微创及开放椎弓根螺钉治疗单纯性胸腰椎骨折的同期对照研究文献。用NOS进行文献质量评价、提取资料，使用ReviewManager 5.3统计学软件进行Meta分析。结果 通过筛选共有13篇文献符合标准，质量评价(NOS评分5～9分)被纳入研究，其中随机对照试验6篇，病例对照试验7篇，共711例，经皮微创组358例，开放组353例。进行Meta分析，结果显示:经皮微创与开放椎弓根螺钉内固定术相比:前者在手术时间、术中失血量、术后引流量、住院时间明显少于后者，差异具有统计学意义(P＜0.01);经皮微创组术前、术后伤椎cobb角恢复程度无异于开放椎弓根螺钉内固定组，差异无统计学意义(P＞0.05);两组术后切口疼痛VAS评分之间的差异具有统计学意义(P＜0.01)。结论 与开放椎弓根螺钉内固定术相比，经皮微创手术具有创伤小、手术时间短、出血量少、住院时间短的优势，而两组在术前、术后伤椎cobb角恢复程度无统计学差异，在术后切口疼痛VAS评分方面，经皮微创组较开放椎弓根螺钉组对术后切口疼痛改善佳。

Percutaneous minimally invasive and open pedicle screw fixation fortreatment of thoracolumbar fractures:a meta-analysis

Objective This is a meta-analysis to compare the treatment and clinical safety of percutaneous minimally invasive with open pedicle screw fixation for thoracolumbar fractures.Methods Databases were identified in computer from Cochrane library,Wanfang database,PubMed and hospital knowledge base.The compared percutaneous minimally invasive with open pedicle screw fixation for treatment of thoracolumbar fractures was included.The Newcastle-Ottawa Scale to evaluate the quality was used;the data of the selected literatures were extracted independently by two reviewers.All data were analyzed by Review Manager 5.3.Results Thirteen literatures (six randomized controlled trial,seven case controlled trial) with 711 patients were included in this meta-analysis (358 patients for percutaneous minimally invasive group,353 patients for open group).Quality evaluation that all of the included literatures were high quality cohort studies (NOS range5-9.The meta-analysis showed that percutaneous minimallyinvasive have shorter operation time,lesser intraoperative time,lesser postoperative drainage,shorter hospital duration time(P＜0.01)compared to open pedicle screw fixation,the improvement of injured vertebrae′s cobb angle was the same between percutaneous minimally invasive and open pedicle screw fixation,and has no statistically significant(P＞0.05).The VAS score of the two group has a high statistical significance(P＜0.01).Conclusion Compared with open pedicle screw fixation,percutaneous minimally invasive had the advantage of smaller invasive,lesser blood loss and shorter hospital duration time,also the improvement of injured vertebrae′s cobb angle was the same between percutaneous minimally invasive and open pedicle screw fixation.However the percutaneous minimally invasive group has less pain than that of open pedicle screw fixationgroup.