At the Fracture Level versus Cross the Fracture Level Short-segment Pedicle Screw Fixation for Thoracolumbar Fractures: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 XIONGWei ¹ ,  LIUJia-guo ¹ , LUOBin ¹ , ZHANGJin-song ¹ , ZHAOMeng ¹ , ZHANGChao ²

1. Department of Orthopedics and Trauma, Shiyan Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China;
2. Center for Evidence-based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China;

Corresponding?author：

LIUJia-guo, Email: 513642097@qq.com

Keywords：

Thoracolumbar fractures; At the Fracture level; Cross the fracture level; Short-segment; Pedicle screw; Randomized controlled trial; Meta-analysis; Systematic review

DOI：

10.7507/1672-2531.20160025

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Objective To systematically review the efficacy of at the fracture level (AFL) versus cross the fracture level (CFL) short-segment pedicle screw fixation for thoracolumbar fractures. Methods We electronically search PubMed, The Cochrane Library (Issue 8, 2015), EMbase, CBM, CNKI, VIP and WanFang data to collect randomized controlled trials (RCTs) of AFL versus CFL short segment pedicle screw fixation for thoracolumbar fractures from inception to Aug. 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was performed using RevMan 5.3 software. Results A total of 11 RCTs involving 730 patients were included. The results of meta-analysis indicated that: compared with the CFL group, the AFL group had more blood loss (MD=9.8, 95%CI 7.40 to 12.20), less implant failure rate (RR=0.19, 95%CI 0.07 to 0.48), lower long term postoperative VAS score of thoracolumbar pain (MD=-1.20, 95%CI -1.85 to -0.56), higher correction in short term postoperative kyphotic Cobb angle (MD=3.56, 95%CI 2.25 to 4.87), smaller value in long term postoperative kyphotic Cobb angle and its loss of correction (MD=-3.95, 95%CI -7.78 to -0.12; MD=-4.65, 95%CI -6.91 to -2.40), smaller degree of anterior vertebral height compression in short and long term postoperative (MD=-3.51, 95%CI -5.23 to -1.80; MD=-8.28, 95%CI -12.22 to -4.33), better result in long term postoperative anterior vertebral height and its loss of correction (MD=8.00, 95%CI 3.85 to 12.15; MD=-6.06, 95%CI -7.68 to -4.44). There were no significant differences between two groups regarding operation time, infectious complications and short term postoperative kyphotic Cobb angle (MD=0.11, 95%CI -5.36 to 5.57; RR=0.55, 95%CI 0.11 to 2.85; MD=-0.66, 95%CI -2.19 to 0.87). Conclusion Current evidence shows that AFL short-segment pedicle screw fixation for thoracolumbar fractures is superior to CFL fixation. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.

Citation： XIONGWei, LIUJia-guo, LUOBin, ZHANGJin-song, ZHAOMeng, ZHANGChao. At the Fracture Level versus Cross the Fracture Level Short-segment Pedicle Screw Fixation for Thoracolumbar Fractures: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2016, 16(2): 143-152. doi: 10.7507/1672-2531.20160025 Copy

1.	Kim BG, Dan JM, Shin DE. Treatment of thoracolumbar fracture. Asian Spine J, 2015, 9(1):133-146.
2.	Abudou M, Chen X, Kong X, et al. Surgical versus non-surgical treatment for thoracolumbar burst fractures without neurological deficit. Cochrane Database Syst Rev, 2013, 6:CD005079.
3.	Xu GJ, Li ZJ, Ma JX, et al. Anterior versus posterior approach for treatment of thoracolumbar burst fractures:a meta-analysis. Eur Spine J, 2013, 22(10):2176-2183.
4.	Scheer JK, Bakhsheshian J, Fakurnejad S, et al. Evidence-Based Medicine of Traumatic Thoracolumbar Burst Fractures:A Systematic Review of Operative Management across 20 Years. Global Spine J, 2015, 5(1):73-82.
5.	Mahar A, Kim C, Wedemeyer M, et al. Short-segment fixation of lumbar burst fractures using pedicle fixation at the level of the fracture. Spine (Phila Pa 1976), 2007, 32(14):1503-1507.
6.	Farrokhi MR, Razmkon A, Maghami Z, et al. Inclusion of the fracture level in short segment fixation of thoracolumbar fractures. Eur Spine J, 2010, 19(10):1651-1656.
7.	Guven O, Kocaoglu B, Bezer M, et al. The use of screw at the fracture level in the treament of thoracolumbar burst fractures. J Spinal Disord Tech, 2009, 22(6):417-421.
8.	常銳, 王豐愛, 王海霞, 等. 傷椎置短釘技術治療胸腰椎爆裂骨折的療效分析. 中國矯形外科雜志, 2014, 22(8):683-686.
9.	賈其余, 王林, 俞宇, 等. 經傷椎與跨傷椎后路短節段內固定治療胸腰椎爆裂骨折的對比研究. 中國骨與關節損傷雜志, 2014, 29(9):869-871.
10.	黎昭華, 湯勇智, 楊立群, 等. 經傷椎與跨傷椎固定治療胸腰段脊柱骨折效果觀察. 白求恩醫學雜志, 2014, 12(6):528-529.
11.	韋蒙, 劉智, 廖文奔, 等. 經傷椎置釘與跨節段螺釘內固定治療胸腰椎骨折的療效比較. 廣西醫學, 2015, 37(5):712-713,716.
12.	許勁羽, 梁紫紅, 何榮龍, 等. 短節段經傷椎和跨傷椎椎弓根固定治療胸腰椎骨折的臨床療效分析. 中國傷殘醫學, 2015, 15(10):43-44.
13.	許天明, 徐永清, 陳建明, 等. 經一側傷椎短節段椎弓根固定聯合椎體內植骨治療胸腰段椎體骨折. 中國骨與關節損傷雜志, 2012, 27(9):789-791.
14.	印飛, 孫振中, 殷渠東, 等. 傷椎植骨植釘與跨節段椎弓根螺釘內固定術治療胸腰椎骨折的比較研究. 中國修復重建外科雜志, 2014, 28(2):227-232.
15.	朱云榮, 葉曉健, 余將民, 等. 短節段經傷椎椎弓根螺釘治療胸腰段骨折. 中華創傷雜志, 2010, 26(3):221-224.
16.	袁志峰, 邵斌, 曾景平. 經傷椎置釘治療胸腰椎骨折的臨床運用及療效分析. 脊柱外科雜志, 2013, 11(1):32-35.
17.	Sapkas G, Kateros K, Papadakis SA, et al. Treatment of unstable thoracolumbar burst fractures by indirect reduction and posterior stabilization:short-segment versus long-segment stabilization. Open Orthop J, 2010, 1(4):7-13.
18.	李晶, 呂國華, 王冰, 等. 胸腰椎骨折脫位傷椎固定的可行性研究. 中華骨科雜志, 2005, 25 (5):293-296.
19.	Anekstein Y, Brosh T, Mirovsky Y. Intermediate screws in short segment pedicular fixation for thoracic and lumbar fractures:a biomechanical study. J Spinal Disord Tech, 2007, 20(1):72-77.
20.	Dick JC, Jones MP, Zdeblick TA, et al. A biomechanical comparison evaluating the use of intermediate screws and cross-linkage in lumbar pedicle fixation. J Spinal Disord, 1994, 7(5):402-407.
21.	Chen C, Lv G, Xu B, et al. Posterior short-segment instrumentation and limited segmental decompression supplemented with vertebroplasty with calcium sulphate and intermediate screws for thoracolumbar burst fractures. Eur Spine J, 2014, 23(7):1548-1557.
22.	Mumford J, Weinstein JN, Spratt KF, et al. Thoracolumbar burst fractures. The clinical efficacy and outcome of nonoperative management. Spine (Phila Pa1976), 1993, 18(8):955-970.
23.	田耘, 周方, 陳仲強, 等. 復雜胸腰椎骨折的傷椎形態特點與傷椎置釘技術. 中華外科雜志, 2010, 48(16):1238-1242.
24.	吳毅, 孫永建, 李偉成, 等. 經傷椎置釘與跨節段椎弓根螺釘置入固定修復胸腰椎骨折的Meta分析. 中國組織工程研究, 2015, 19(22):3604-3608.
25.	劉雪梅, 李琰, 蔣蘭慧, 等. 實施研究倫理和發表倫理, 促進規范研究、規范出版和規范轉化——中國臨床試驗注冊和發表協作網第二次聲明背景文件. 中國循證醫學雜志, 2011, 11(7):726-732.
26.	吳泰相, 李幼平, 劉關鍵, 等. 中國臨床試驗注冊中心及中國循證醫學中心提高我國臨床試驗質量的策略和措施. 中國循證醫學雜志, 2010, 10(11):1243-1248.

1. Kim BG, Dan JM, Shin DE. Treatment of thoracolumbar fracture. Asian Spine J, 2015, 9(1):133-146.
2. Abudou M, Chen X, Kong X, et al. Surgical versus non-surgical treatment for thoracolumbar burst fractures without neurological deficit. Cochrane Database Syst Rev, 2013, 6:CD005079.
3. Xu GJ, Li ZJ, Ma JX, et al. Anterior versus posterior approach for treatment of thoracolumbar burst fractures:a meta-analysis. Eur Spine J, 2013, 22(10):2176-2183.
4. Scheer JK, Bakhsheshian J, Fakurnejad S, et al. Evidence-Based Medicine of Traumatic Thoracolumbar Burst Fractures:A Systematic Review of Operative Management across 20 Years. Global Spine J, 2015, 5(1):73-82.
5. Mahar A, Kim C, Wedemeyer M, et al. Short-segment fixation of lumbar burst fractures using pedicle fixation at the level of the fracture. Spine (Phila Pa 1976), 2007, 32(14):1503-1507.
6. Farrokhi MR, Razmkon A, Maghami Z, et al. Inclusion of the fracture level in short segment fixation of thoracolumbar fractures. Eur Spine J, 2010, 19(10):1651-1656.
7. Guven O, Kocaoglu B, Bezer M, et al. The use of screw at the fracture level in the treament of thoracolumbar burst fractures. J Spinal Disord Tech, 2009, 22(6):417-421.
8. 常銳, 王豐愛, 王海霞, 等. 傷椎置短釘技術治療胸腰椎爆裂骨折的療效分析. 中國矯形外科雜志, 2014, 22(8):683-686.
9. 賈其余, 王林, 俞宇, 等. 經傷椎與跨傷椎后路短節段內固定治療胸腰椎爆裂骨折的對比研究. 中國骨與關節損傷雜志, 2014, 29(9):869-871.
10. 黎昭華, 湯勇智, 楊立群, 等. 經傷椎與跨傷椎固定治療胸腰段脊柱骨折效果觀察. 白求恩醫學雜志, 2014, 12(6):528-529.
11. 韋蒙, 劉智, 廖文奔, 等. 經傷椎置釘與跨節段螺釘內固定治療胸腰椎骨折的療效比較. 廣西醫學, 2015, 37(5):712-713,716.
12. 許勁羽, 梁紫紅, 何榮龍, 等. 短節段經傷椎和跨傷椎椎弓根固定治療胸腰椎骨折的臨床療效分析. 中國傷殘醫學, 2015, 15(10):43-44.
13. 許天明, 徐永清, 陳建明, 等. 經一側傷椎短節段椎弓根固定聯合椎體內植骨治療胸腰段椎體骨折. 中國骨與關節損傷雜志, 2012, 27(9):789-791.
14. 印飛, 孫振中, 殷渠東, 等. 傷椎植骨植釘與跨節段椎弓根螺釘內固定術治療胸腰椎骨折的比較研究. 中國修復重建外科雜志, 2014, 28(2):227-232.
15. 朱云榮, 葉曉健, 余將民, 等. 短節段經傷椎椎弓根螺釘治療胸腰段骨折. 中華創傷雜志, 2010, 26(3):221-224.
16. 袁志峰, 邵斌, 曾景平. 經傷椎置釘治療胸腰椎骨折的臨床運用及療效分析. 脊柱外科雜志, 2013, 11(1):32-35.
17. Sapkas G, Kateros K, Papadakis SA, et al. Treatment of unstable thoracolumbar burst fractures by indirect reduction and posterior stabilization:short-segment versus long-segment stabilization. Open Orthop J, 2010, 1(4):7-13.
18. 李晶, 呂國華, 王冰, 等. 胸腰椎骨折脫位傷椎固定的可行性研究. 中華骨科雜志, 2005, 25 (5):293-296.
19. Anekstein Y, Brosh T, Mirovsky Y. Intermediate screws in short segment pedicular fixation for thoracic and lumbar fractures:a biomechanical study. J Spinal Disord Tech, 2007, 20(1):72-77.
20. Dick JC, Jones MP, Zdeblick TA, et al. A biomechanical comparison evaluating the use of intermediate screws and cross-linkage in lumbar pedicle fixation. J Spinal Disord, 1994, 7(5):402-407.
21. Chen C, Lv G, Xu B, et al. Posterior short-segment instrumentation and limited segmental decompression supplemented with vertebroplasty with calcium sulphate and intermediate screws for thoracolumbar burst fractures. Eur Spine J, 2014, 23(7):1548-1557.
22. Mumford J, Weinstein JN, Spratt KF, et al. Thoracolumbar burst fractures. The clinical efficacy and outcome of nonoperative management. Spine (Phila Pa1976), 1993, 18(8):955-970.
23. 田耘, 周方, 陳仲強, 等. 復雜胸腰椎骨折的傷椎形態特點與傷椎置釘技術. 中華外科雜志, 2010, 48(16):1238-1242.
24. 吳毅, 孫永建, 李偉成, 等. 經傷椎置釘與跨節段椎弓根螺釘置入固定修復胸腰椎骨折的Meta分析. 中國組織工程研究, 2015, 19(22):3604-3608.
25. 劉雪梅, 李琰, 蔣蘭慧, 等. 實施研究倫理和發表倫理, 促進規范研究、規范出版和規范轉化——中國臨床試驗注冊和發表協作網第二次聲明背景文件. 中國循證醫學雜志, 2011, 11(7):726-732.
26. 吳泰相, 李幼平, 劉關鍵, 等. 中國臨床試驗注冊中心及中國循證醫學中心提高我國臨床試驗質量的策略和措施. 中國循證醫學雜志, 2010, 10(11):1243-1248.

Chinese Journal of Evidence-Based Medicine

At the Fracture Level versus Cross the Fracture Level Short-segment Pedicle Screw Fixation for Thoracolumbar Fractures: A Meta-analysis

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