多节段Ponte截骨与全脊椎截骨矫正复杂脊柱畸形有效性与安全性比较的Meta分析

A meta-analysis comparing the efficacy and safety of multi-level Ponte osteotomy and vertebral column resection in correcting complex spinal deformities

中文关键词:  脊柱畸形  多节段Ponte截骨  全脊椎截骨  脊柱侧凸  后凸畸形  Meta分析

英文关键词:Spinal deformity  Multi-level Ponte osteotomy  Vertebral column resection  Scoliosis  Kyphosis  Meta analysis

中文摘要:

  【摘要】 目的：系统比较多节段Ponte截骨与全脊椎截骨（vertebral column resection，VCR）对于矫正复杂脊柱畸形的有效性与安全性。方法：计算机检索2023年6月之前中国知网、万方、维普、PubMed、Cochrane Library、EMBASE和CBM数据库收录的有关Ponte截骨和VCR矫正复杂脊柱畸形效果对比的临床研究文献，由3位研究人员独立进行文献筛选、资料提取，综合运用改良后的Jadad评分量表和NOS评分量表对纳入文献进行质量评价，纳入指标包括：手术时间、术中出血量、术后并发症、脊柱主弯Cobb角矫正率、脊柱后凸矫正率、SRS-22量表评分、脊柱主弯Cobb角矫正丢失、脊柱后凸畸形矫正丢失，使用Revman 5.3软件进行Meta分析。结果：共纳入6篇文献，均为队列研究，其中1篇Jadad量表评分为3分、质量等级评为B级，5篇Jadad以及NOS量表评分均大于5分。共纳入198例复杂脊柱畸形病例，其中多节段Ponte截骨118例（Ponte截骨），VCR 80例（VCR组）。分析结果显示，Ponte截骨比VCR手术时间更短[OR=-43.08，95%CI（-58.46，-27.70），Z=5.49，P<0.00001]、术中出血量更少[OR=-214.06，95%CI（-336.10，-92.02），Z=3.44，P=0.0006]、术后并发症更少[OR=0.13，95% CI（0.05，0.31），Z=4.50，P<0.00001]，两组比较均有统计学差异；两种术式在主弯Cobb角矫正率[OR=1.53，95%CI（-3.24，6.31），Z=0.63，P>0.05]、后凸矫正率[OR=6.40，95%CI（-0.35，13.15），Z=1.89，P>0.05]、SRS-22量表评分[OR=-0.06，95%CI（-0.44，0.33），Z=0.29，P>0.05]、主弯Cobb角矫正丢失[OR=0.15，95%CI （-1.08，1.38），Z=0.24，P>0.05]、脊柱后凸畸形矫正丢失[OR=0.33，95%CI（-3.44，4.10），Z=0.17，P>0.05]等无统计学差异。结论：多节段Ponte截骨与VCR对于矫正复杂脊柱畸形的临床疗效一致，但Ponte截骨在手术时间、术中出血量以及术后并发症少于VCR，是一种更加安全有效的方法。

英文摘要:

  【Abstract】 Objectives: To systematically evaluate and compare the efficacy and safety of multi-level Ponte osteotomy and vertebral column resection(VCR) in the correction of complex spinal deformities. Methods: The clinical research literatures on the comparison of the effects of two surgical methods(Ponte osteotomy and VCR) on the correction of complex spinal deformities in CNKI, Wanfang, VIP, PubMed, Cochrane Library, EMBASE and CBM databases until June 2023 were retrieved by computer. Three researchers independently screened literatures and extracted data, and comprehensively evaluated the quality of the included literatures by using the modified Jadad scale and Newcastle-Ottawa Scale(NOS). The included indicators were operative time, intraoperative blood loss, postoperative complications, Cobb angle correction rate of main curve, kyphosis correction rate, SRS-22 score, Cobb angle correction loss of main curvae, kyphosis correction loss, and Revman 5.3 software was used for meta-analysis. Results: A total of 6 literatures were included, including 1 cohort study with Jadad scale score of 3 and quality grade of B, and 5 cohort studies with Jadad and NOS scale scores of more than 5. A total of 198 patients with complex spinal deformities after operation were included, consisting of 118 cases undergone multi-level Ponte osteotomy(Ponte group) and 80 cases undergone VCR(VCR group). The results showed that comparing with VCR, multi-level Ponte osteotomy had shorter operative time[OR=-43.08, 95%CI(-58.46, -27.70), Z=5.49, P<0.00001], less blood loss[OR=-214.06, 95%CI (-336.10, -92.02), Z=3.44, P=0.0006] and less postoperative complications[OR=0.13, 95%CI(0.05, 0.31), Z=4.50, P<0.00001]; There was no statistical difference in postoperative Cobb angle correction rate[OR=1.53, 95%CI(-3.24, 6.31), Z=0.63, P>0.05], kyphosis correction rate[OR=6.40, 95%CI(-0.35, 13.15), Z=1.89, P>0.05], SRS-22 score[OR=-0.06, 95%CI(-0.44, 0.33), Z=0.29, P>0.05], Cobb angle correction loss[OR=0.15, 95%CI(-1.08, 1.38), Z=0.24, P>0.05], and correction loss of kyphosis[OR=0.33, 95%CI(-3.44, 4.10), Z=0.17, P>0.05] between the two groups. Conclusions: The clinical effects of multi-level Ponte osteotomy and VCR for the correction of complex spinal deformities are similar, but Ponte osteotomy is better than VCR in operative time, intraoperative blood loss and postoperative complications, which is a more safe and effective method.