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《The Journal of Traditional Chinese Orthopedics and Traumatology》 2018-08
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Primary debridement combined with bone grafting and internal fixation through anterior approach versus posterior approach for treatment of thoracolumbar tuberculosis: a meta analysis

HE Guozhong;YING Yongsheng;YU Chunsheng;LIU Binggen;Yongkang Orthopedic Hospital;The Second Hospital of Ningbo City;  
Objective: To investigate the curative effect and safety of primary debridement combined with bone grafting and internal fixation through anterior approach versus posterior approach for treatment of thoracolumbar tuberculosis. Methods: All the randomized controlled trial( RCT) articles,prospective cohort study articles and retrospective cohort study articles about primary debridement combined with bone grafting and internal fixation through anterior approach( anterior approach group) versus posterior approach( posterior approach group)for treatment of thoracolumbar tuberculosis that published at home and abroad included from database establishing to July 2017 were retrieved from Cochrane Library,Pubmed,Ovid,Spinger Link,Elsevier,China national knowledge internet and Wan Fang Data through computer. The articles were screened and the information was extracted independently by two searchers. The methodological quality of research in the articles was evaluated according to the Newcastle-Ottawa scale( NOS) and a Meta-analysis was conducted by using Rev Man 5. 0 software. Results: Two thousand seven hundred and ninety-four articles were searched out. After screening,13 articles( 6 English articles and7 Chinese articles) were included in the final analysis,including 6 prospective cohort study articles,6 retrospective cohort study articles and1 RCT article,576 patients in anterior approach group and 614 patients in posterior approach group,and the NOS scores were 8 points in 8 articles and 7 points in 5 articles. The results of Meta-analysis demonstrated that there was no statistical difference in operative time,intraoperative blood loss,hospital stay and loss of spinal kyphotic Cobb's angle at last follow-up between the 2 groups( WMD =-2. 08,95%CI(-39. 59,35. 43); WMD =-35. 50,95% CI(-103. 16,32. 16); WMD = 0. 69,95% CI(-2. 06,3. 43); WMD = 0. 15,95% CI(-0. 44,0. 73)). The correction degree of spinal kyphotic Cobb's angle was smaller,the time of bone graft fusion was shorter and the postoperative complication incidences were higher in anterior approach group compared to posterior approach group(( WMD =-2. 14,95% CI(-3. 22,-1. 06); WMD =-0. 21,95% CI(-0. 35,-0. 07); OR = 1. 67,95% CI( 1. 02,2. 72)). Conclusion: Primary debridement combined with bone grafting and internal fixation through posterior approach can better correct the kyphotic deformity compared to primary debridement combined with bone grafting and internal fixation through anterior approach in treatment of thoracolumbar tuberculosis,and it has less postoperative complications. However,the former needs longer bone graft fusion time compared to the latter.
【CateGory Index】: R687.3
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