Short-Segment Fixation in the Management of Thoracolumbar Burst Fractures - A Meta -analysis.

Laxmikant Dagdia, Saurabh Shrikant Kulkarni, Girish N Gadekar
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Abstract

Introduction: Short- segment fixation is being increasingly used to minimiz e the number of fixation levels in thoracolumbar burst fractures (TLBFs). This study aims to analyze the radiological, functional, and neurological outcomes of short-segment fixation in TLBF.

Materials and methods: A meta-analysis was conducted through a web search on PubMed with the following keywords; thoracolumbar injury, burst fracture, and short- segment fixation. Scientific papers written in English from January 2001 to April 2024 were screened. PubMed search with the keywords revealed 183 articles which were thoroughly reviewed by all the authors. Of these, 11 studies satisfying the inclusion criteria describing short- segment fixation in TLBF s were included in this study. The minimum follow-up duration in each study was 12 months. The appropriate meta-analysis was carried out, and the forest plot for a single group which accounts for interstudy variation and provides a more conservative effect than the fixed effect model. Potential sources of heterogeneity were assessed using the standard chi-square test. In addition, the statistic I2 was used to investigate heterogeneity by examining the extent of inconsistency across the study results. A sensitivity analysis was carried out to assess the robustness of the results of the meta-analysis. Where heterogeneity was present between the studies, differences in study design were examined. All analyses were performed using online free meta-analysis software (https://metaanalysisonline.com).

Results: The results of this meta-analysis suggested that studies with an added intermediate screw at the level of fractured vertebra showed a better radiological appearance at the final follow- up as compared to traditional short-segment instrumentation. However, clinical outcomes showed no significant difference. A post-surgery neurological improvement was noted in all the studies except those with a complete pre-operative neurological deficit.

Conclusion: Short-segment instrumentation with intermediate screw fixation is a safe and effective method with excellent radiological and clinical outcomes with very low rates of failure while treating unstable TLBFs, where as traditional short-segment posterior fixation can lead to progressive loss of kyphosis correction with higher implant failure rate in patients with unstable fractures.

短节段内固定治疗胸腰椎爆裂性骨折的Meta分析。
短节段固定越来越多地用于减少胸腰椎爆裂骨折(TLBFs)的固定水平。本研究旨在分析TLBF短节段固定的放射学、功能和神经学结果。材料和方法:在PubMed网站上搜索以下关键词进行meta分析;胸腰椎损伤,爆裂性骨折,短节段固定。筛选了2001年1月至2024年4月用英文撰写的科学论文。在PubMed上搜索关键词,发现了183篇文章,这些文章都经过了所有作者的彻底审查。其中,11项符合TLBF短节段固定的研究被纳入本研究。每项研究的最短随访时间为12个月。我们进行了适当的荟萃分析,单一组的森林图解释了研究间的变化,并提供了比固定效应模型更保守的效应。使用标准卡方检验评估异质性的潜在来源。此外,统计量I2通过检查研究结果的不一致程度来调查异质性。进行敏感性分析以评估meta分析结果的稳健性。如果研究之间存在异质性,则检查研究设计的差异。所有分析均使用在线免费荟萃分析软件(https://metaanalysisonline.com).Results)进行:该荟萃分析的结果表明,与传统短节段内固定相比,在骨折椎体水平增加中间螺钉的研究在最终随访时显示出更好的放射学外观。然而,临床结果无显著差异。手术后神经系统的改善在所有的研究中都被注意到,除了那些术前有完全的神经功能缺陷的研究。结论:短节段内固定联合中间螺钉固定是治疗不稳定TLBFs的一种安全有效的方法,具有良好的放射学和临床效果,失败率极低,而传统的短节段后路固定会导致不稳定骨折患者后凸矫正的进行性丧失,内固定失败率较高。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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