不伴神经损伤的胸腰椎爆裂骨折保守和手术治疗效果对比:一项荟萃分析

发布时间：2018-03-06 04:09

  本文选题：胸腰椎爆裂骨折不伴神经损伤　切入点：保守治疗　出处：《中国矫形外科杂志》2017年02期 　论文类型：期刊论文

【摘要】：[目的]系统评价保守和手术治疗不伴神经损伤的胸腰椎爆裂骨折的有效性和安全性差异。[方法]计算机检索Pubmed、Embase、Cochrane图书馆、中国生物医学文献数据库(CBM)、万方数据及中国知网等6个常用的中英文电子数据库,收录有关保守和手术治疗不伴神经损伤的胸腰椎爆裂骨折的临床随机对照研究,检索文献截至2015年9月。按照纳入标准和排除标准限定研究对象,采用改良的Jadad评分量表进行文献质量评估,运用RevMan 5.3软件对提取的有效数据进行Meta分析。[结果]纳入4项临床随机对照研究,共计患者239人,最终完成随访212人,其中保守组112例,手术组100例,随访12~268个月。Meta分析显示无论接受保守还是手术治疗的患者,在治疗后疼痛感受(VAS评分)、功能恢复(RMDQ-24)及重返工作方面比较差异均无统计学意义,但手术组患者后凸畸形的改善明显优于保守组,而保守组在治疗后的并发症和医疗花费方面要优于手术组。[结论]对于不伴神经损伤的胸腰椎爆裂骨折无论是保守还是手术治疗,两者的中远期临床结果相似,保守治疗具有并发症低、医疗花费少等优势。但由于各研究起始年月较早,手术方式较为传统,近年来兴起的微创治疗等手段与保守治疗的对比尚需更多高质量的前瞻临床对照研究进一步增强循证依据。
[Abstract]:[objective] to evaluate the efficacy and safety of conservative and surgical treatment of thoracolumbar burst fractures without nerve injury. [methods] Pubmedmedus Embase Cochrane Library was searched by computer. The Chinese Biomedical Literature Database (CBMX), Wanfang data and China Zhiwang are six commonly used electronic databases in both Chinese and English, which include clinical randomized controlled studies on conservative and surgical treatment of thoracolumbar burst fractures without nerve injury. As of September 2015, according to the inclusion criteria and exclusion criteria, the literature quality was evaluated by the modified Jadad scoring scale. The effective data were analyzed by Meta using RevMan 5.3 software. [results] in 4 randomized controlled clinical trials, a total of #number0# patients were followed up, including 112 cases in conservative group and 100 cases in operation group. Follow-up analysis of 12 ~ 268 months. Meta-analysis showed that there was no significant difference in VAS scores, functional recovery and RMDQ-24) and return to work in patients who received conservative or surgical treatment after treatment. But the improvement of kyphosis in operation group was better than that in conservative group. But the conservative group is superior to the surgical group in terms of complications and medical cost after treatment. [conclusion] for thoracolumbar burst fracture without nerve injury, the middle and long term clinical results of both groups are similar, whether conservative or surgical. Conservative treatment has the advantages of low complications and less medical cost. However, due to the early onset of each study, the operation method is more traditional. The comparison between minimally invasive therapy and conservative therapy in recent years requires more high-quality prospective clinical controlled studies to further strengthen the evidence-based evidence-based evidence-based evidence-based evidence-based evidence-based study.
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本文编号：1573254