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Comparison of the adverse events of percutaneous pedicle screw fixation and traditional open pedicle screw fixation for thoracolumbar fractures: a Meta-analysis
- SUN Xiangyao, HAI Yong, ZHANG Xinuo
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JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES). 2016, 54(11):
56-63.
doi:10.6040/j.issn.1671-7554.0.2016.901
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Objective To systematically review the adverse events of percutaneous pedicle screw fixation(PPSF)and traditional open pedicle screw fixation(TOPSF)for thoracolumbar fracture, in order to provide more evidence for the effective treatment of thoracolumbar fracture. Methods Databases including Pubmed, Cochrane Central Register of Controlled Trails(CENTRAL), and Embase were retrieved with computer. Journal of Bone and Joint Surgery, Spine, 山 东 大 学 学 报 (医 学 版)54卷11期 -孙祥耀,等.经皮内固定术与传统后路开放内固定术治疗胸腰椎骨折不良事件比较的Meta分析 \=-and European Spine Journal were manually searched. The searching terms were thoracolumbar fracture, lumbar fracture, percutaneous pedicle screw fixation, open fixation, posterior surgery, sextant, traditional fixation, conventional fixation, minimally invasive surgery, comparative study, randomized controlled trail, and clinical trail. Data were then screened, extracted, assessed, and analyzed with RevMan 5.3 software. Results A total of 18 studies including 4 randomized controlled trials, 3 prospective comparative studies, 11 retrospective comparative studies were enrolled, involving 1,034 patients. Meta-analysis showed that the PPSF group, compared with the TOPSF group, had shorter surgery time(WMD=-0.95, 95%CI: -1.33 - 0.57, P<0.001), less intraoperative blood loss(WMD=-2.97, 95%CI: -3.69 - 2.25, P<0.001), less postoperative drainage amount(WMD=-2.43, 95%CI: -3.04 - 1.83, P<0.001), shorter hospital stay(WMD=-5.37, 95%CI: -6.69 - 4.05, P<0.001), less time from surgery to walking(WMD=-2.51, 95%CI: -3.66 - 1.36, P<0.001), less overall postoperative visual analogue scale(WMD=-1.14, 95%CI: -1.62 - 0.66, P<0.001), lower postoperative Oswestry disability index(WMD=-1.78, 95%CI: -3.00 - 0.55, P=0.004), less postoperative Cobb angle correction loss(WMD=-0.52, 95%CI: -0.93 - 0.11, P=0.01), longer intraoperative exposure to radiation(WMD=5.12, 95%CI: 2.89-7.34, P<0.001). However, no significant difference was found between the two groups with regard to the rate of screw misplacement(OR=1.04, 95%CI: 0.43-2.56, P=0.92)and the rate of infection(OR=0.39, 95%CI: 0.12-1.26, P=0.12). Conclusion PPSF can not only shorten surgery time, hospital stay, and time from surgery to walking, but also lessen intraoperative blood loss, postoperative drainage amount, postoperative visual analogue scale, postoperative Oswestry disability index, and postoperative Cobb angle correction loss, but achieve the same accuracy in pedicle screw placement as TOPSF and secure the operation. Meanwhile, PPSF can protect the surrounding soft tissues, and reduce the rate of adverse events.
