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

Video：

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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.	常锐, 王丰爱, 王海霞, 等. 伤椎置短钉技术治疗胸腰椎爆裂骨折的疗效分析. 中国矫形外科杂志, 2014, 22(8):683-686.
9.	贾其余, 王林, 俞宇, 等. 经伤椎与跨伤椎后路短节段内固定治疗胸腰椎爆裂骨折的对比研究. 中国骨与关节损伤杂志, 2014, 29(9):869-871.
10.	黎昭华, 汤勇智, 杨立群, 等. 经伤椎与跨伤椎固定治疗胸腰段脊柱骨折效果观察. 白求恩医学杂志, 2014, 12(6):528-529.
11.	韦蒙, 刘智, 廖文奔, 等. 经伤椎置钉与跨节段螺钉内固定治疗胸腰椎骨折的疗效比较. 广西医学, 2015, 37(5):712-713,716.
12.	许劲羽, 梁紫红, 何荣龙, 等. 短节段经伤椎和跨伤椎椎弓根固定治疗胸腰椎骨折的临床疗效分析. 中国伤残医学, 2015, 15(10):43-44.
13.	许天明, 徐永清, 陈建明, 等. 经一侧伤椎短节段椎弓根固定联合椎体内植骨治疗胸腰段椎体骨折. 中国骨与关节损伤杂志, 2012, 27(9):789-791.
14.	印飞, 孙振中, 殷渠东, 等. 伤椎植骨植钉与跨节段椎弓根螺钉内固定术治疗胸腰椎骨折的比较研究. 中国修复重建外科杂志, 2014, 28(2):227-232.
15.	朱云荣, 叶晓健, 余将民, 等. 短节段经伤椎椎弓根螺钉治疗胸腰段骨折. 中华创伤杂志, 2010, 26(3):221-224.
16.	袁志峰, 邵斌, 曾景平. 经伤椎置钉治疗胸腰椎骨折的临床运用及疗效分析. 脊柱外科杂志, 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, 吕国华, 王冰, 等. 胸腰椎骨折脱位伤椎固定的可行性研究. 中华骨科杂志, 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, 陈仲强, 等. 复杂胸腰椎骨折的伤椎形态特点与伤椎置钉技术. 中华外科杂志, 2010, 48(16):1238-1242.
24.	吴毅, 孙永建, 李伟成, 等. 经伤椎置钉与跨节段椎弓根螺钉置入固定修复胸腰椎骨折的Meta分析. 中国组织工程研究, 2015, 19(22):3604-3608.
25.	刘雪梅, 李琰, 蒋兰慧, 等. 实施研究伦理和发表伦理, 促进规范研究、规范出版和规范转化——中国临床试验注册和发表协作网第二次声明背景文件. 中国循证医学杂志, 2011, 11(7):726-732.
26.	吴泰相, 李幼平, 刘关键, 等. 中国临床试验注册中心及中国循证医学中心提高我国临床试验质量的策略和措施. 中国循证医学杂志, 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. 常锐, 王丰爱, 王海霞, 等. 伤椎置短钉技术治疗胸腰椎爆裂骨折的疗效分析. 中国矫形外科杂志, 2014, 22(8):683-686.
9. 贾其余, 王林, 俞宇, 等. 经伤椎与跨伤椎后路短节段内固定治疗胸腰椎爆裂骨折的对比研究. 中国骨与关节损伤杂志, 2014, 29(9):869-871.
10. 黎昭华, 汤勇智, 杨立群, 等. 经伤椎与跨伤椎固定治疗胸腰段脊柱骨折效果观察. 白求恩医学杂志, 2014, 12(6):528-529.
11. 韦蒙, 刘智, 廖文奔, 等. 经伤椎置钉与跨节段螺钉内固定治疗胸腰椎骨折的疗效比较. 广西医学, 2015, 37(5):712-713,716.
12. 许劲羽, 梁紫红, 何荣龙, 等. 短节段经伤椎和跨伤椎椎弓根固定治疗胸腰椎骨折的临床疗效分析. 中国伤残医学, 2015, 15(10):43-44.
13. 许天明, 徐永清, 陈建明, 等. 经一侧伤椎短节段椎弓根固定联合椎体内植骨治疗胸腰段椎体骨折. 中国骨与关节损伤杂志, 2012, 27(9):789-791.
14. 印飞, 孙振中, 殷渠东, 等. 伤椎植骨植钉与跨节段椎弓根螺钉内固定术治疗胸腰椎骨折的比较研究. 中国修复重建外科杂志, 2014, 28(2):227-232.
15. 朱云荣, 叶晓健, 余将民, 等. 短节段经伤椎椎弓根螺钉治疗胸腰段骨折. 中华创伤杂志, 2010, 26(3):221-224.
16. 袁志峰, 邵斌, 曾景平. 经伤椎置钉治疗胸腰椎骨折的临床运用及疗效分析. 脊柱外科杂志, 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, 吕国华, 王冰, 等. 胸腰椎骨折脱位伤椎固定的可行性研究. 中华骨科杂志, 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, 陈仲强, 等. 复杂胸腰椎骨折的伤椎形态特点与伤椎置钉技术. 中华外科杂志, 2010, 48(16):1238-1242.
24. 吴毅, 孙永建, 李伟成, 等. 经伤椎置钉与跨节段椎弓根螺钉置入固定修复胸腰椎骨折的Meta分析. 中国组织工程研究, 2015, 19(22):3604-3608.
25. 刘雪梅, 李琰, 蒋兰慧, 等. 实施研究伦理和发表伦理, 促进规范研究、规范出版和规范转化——中国临床试验注册和发表协作网第二次声明背景文件. 中国循证医学杂志, 2011, 11(7):726-732.
26. 吴泰相, 李幼平, 刘关键, 等. 中国临床试验注册中心及中国循证医学中心提高我国临床试验质量的策略和措施. 中国循证医学杂志, 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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