长节段与短节段内固定融合治疗退变性脊柱侧凸临床疗效及并发症的Meta分析

Outcomes and complications of long segment and short segment fixation in the treatment of degenerative scoliosis: a Meta-analysis

中文关键词:  退变性脊柱侧凸  内固定融合  长节段  短节段  Meta分析

英文关键词:Degenerative scoliosis  Internal fixation  Long segment  Short segment  Meta-analysis

中文摘要:

  【摘要】 目的：运用Meta分析比较长节段内固定融合与短节段内固定融合治疗退变性脊柱侧凸（degenerative scoliosis，DS）的临床疗效及并发症。方法：计算机检索中国知网、万方、维普中文数据库、CBM、Embase、PubMed、Web of Science、Cochrane library中有关长节段与短节段内固定融合治疗DS的文献，包括随机对照试验和队列研究，检索时间为数据库建库至2020年10月。并手工查阅《中华骨科杂志》《中国脊柱脊髓杂志》《Euro Spine》《Spine》等权威杂志和相关会议论文集，以及对相关论文进行参考文献追踪。从文献中提取包括手术时间、术中出血量、住院时间、侧凸改善、目测类比评分（VAS评分）、Oswestry功能障碍指数（ODI），以及术后并发症等数据，利用 RevMan 5.3软件进行Meta分析。结果：共纳入文献29篇，包括英文文献9篇，中文文献20篇，共计患者1982例，其中长节段固定患者956例，短节段固定患者1026例。短节段组在手术时间[加权均数差（weighted mean difference，WMD）=2.30，95%CI：1.84，2.76，P<0.00001]、术中出血量（WMD=4.05，95%CI：3.20，4.89，P<0.00001）、术中大出血的发生[相对危险度（risk ratio，RR）=3.61，95%CI：1.13，11.58，P<0.05]等手术指标方面均优于长节段组，术后并发症发生率更低（RR=2.02，95%CI：1.42, 2.88，P<0.0001）；长节段组在侧凸改善[标准化均数差（standard mean difference，SMD）=2.26，95%CI：3.20，4.89，P<0.0001]，重建冠状面平衡（WMD=7.04，95%CI：3.42，10.67，P=0.0001）和矢状面平衡（WMD=6.63，95%CI：1.47，11.79，P<0.05）以及ODI改善（WMD=-2.66，95%CI：-3.90，-1.42，P=0.0004）等评价指标上更具优势，差异具有统计学意义（P<0.05）；VAS评分两组间无显著性差异（P>0.05）。结论：长节段固定融合对于矫正畸形和重建脊柱平衡更有优势，而短节段固定在同样有效改善患者疼痛和神经症状的同时，具有较低的术后并发症发生率。因此选择手术方案时应针对不同患者的症状，结合畸形及冠、矢状面失平衡程度进行综合考虑。

英文摘要:

  【Abstract】 Objectives: Meta-analysis was used to compare and evaluate the benefits and risks of long segment internal fixation fusion and short segment internal fixation fusion for the treatment of degenerative scoliosis(DS). Methods: Literature related to long-term and short-term internal fixation fusion therapy for degeneration from CNKI, Wanfang Database, VIP, CBM, Embase, PubMed, Web of Science and Cochrane Library, including randomized controlled trials and cohort studies, were collected. The retrieval time was from inception to October 2020. Authoritative journals such as China Orthopedics Journal, Euro Spine, Chinese Journal of Spine and Spinal Cord and relevant conference proceedings, and followed up relevant references were manually consulted. Extraction from the literature included operation time, intraoperative blood loss, length of hospital stay, Cobb angle improvement, visual analogue scale(VAS) score, Oswestry disability index(ODI), postoperative complications. The included studies were analyzed using RevMan 5.3 software. Results: In the end, 29 references were included, including 9 in English and 20 in Chinese, with a total of 1,982 patients, including 956 patients with long segment fixation and 1026 patients with short segment fixation. The short segment group was superior to the long segment group in terms of operation time[WMD(weighted mean difference)=2.30, 95%CI: 1.84, 2.76, P<0.00001], intraoperative blood loss(WMD=4.05, 95%CI: 3.20, 4.89, P<0.00001), intraoperative massive hemorrhage[RR(risk ratio)=3.61, 95%CI: 1.13,11.58, P<0.05], and was associated with a small incidence of postoperative complications(RR=2.02, 95%CI: 1.42, 2.88, P<0.0001). However, the long segment group had more advantages in correcting Cobb angle[SMD(standard mean difference)=2.26, 95%CI: 3.20, 4.89, P<0.0001], rebuilding coronalbalance(WMD=7.04, 95%CI: 3.42, 10.67, P=0.0001) and sagittal balance(WMD=6.63, 95%CI: 1.47, 11.79, P<0.05), and improving ODI(WMD=-2.66, 95%CI: -3.90, -1.42, P=0.0004), and the differences were statistically significant(P<0.05); There was no significant difference in VAS between the two groups(P>0.05). Conclusions: Compared with the short segment internal fixation, the long segment internal fixation is more effective in correcting malformations and restoring spinal balance. However, the short segment internal fixation is associated with fewer complications, and it is also effective in relieving pain and neurological sign. Therefore, it′s necessary to consider the symptoms of different patients, as well as the degrees of deformity and the imbalance of coronal and sagittal planes comprehensively when deciding surgical procedures.