下胸腰椎损伤减压和稳定手术的技术选择分析:文献的系统回顾

A. Afaunov, N. S. Chaikin
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引用次数: 0

摘要

本系统综述的目的是分析手术治疗下胸腰椎损伤患者的各种技术选择的临床疗效。该综述包括2001-2022年间发表的57项研究,这些研究从主要的医学数据库PubMed、Medline和Cochrane系统综述数据库中选择。在这些出版物中,确定了手术干预的五种选择,其临床有效性取决于神经系统疾病的消退程度,实现重新定位的质量,手术后两年内矫形损失的数量,并发症的数量,手术持续时间和出血量。对于组间两两比较,在初步确定组内数据分布正态性的基础上,对多个独立样本使用Kruskal - Wallis检验。为了确定手术前后参数的差异,对两个相关样本采用Wilcoxon检验。p < 0.05认为差异有统计学意义。对文献资料的分析表明,在胸椎或下腰椎脊髓损伤患者中,采用五种不同类型的手术治疗,其神经系统的恢复动态没有差异。各研究组对损伤脊柱运动节段后凸畸形的矫正质量也无差异。通过后外侧入路和联合入路进行一期环周减压的患者,其畸形矫正损失在统计学上显著降低。值得注意的是,通过孤立的后路或前路进行的手术具有相当的矫正损失值。后路硬脑膜囊减压手术的特点是手术干预时间明显短于前路和联合入路减压手术。经孤立后路减压术中失血量最小。失血量最大的是后外侧入路和一期环周减压组。经后路手术的并发症发生率明显低于经前路手术的并发症发生率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Analysis of technical options for decompression and stabilization surgery for injuries of the lower thoracic and lumbar spine: a systematic review of the literature
The objective of this systematic review was to analyze the clinical efficacy of various technical options for surgical treatment of patients with injuries to the lower thoracic and lumbar spine. The review includes 57 studies published in 2001–2022, which were selected from the main medical databases – PubMed, Medline, and The Cochrane Database of Systematic Reviews. In these publications, five options for surgical intervention were identified, the clinical effectiveness of which was determined by the degree of regression of neurological disorders, the quality of the achieved reposition, the amount of loss of correction within two years after surgery, the number of complications, the duration of operations, and the amount of blood loss. For pairwise comparison between groups, the Kruskal – Wallis test was used for several independent samples, based on the initial determination of the normality of data distribution in groups. To determine the differences between the parameters before and after the operation, the Wilcoxon test was used for two dependent samples. Differences were considered statistically significant at p < 0.05. An analysis of the literature data showed that there are no differences in the dynamics of neurological recovery in patients with spinal cord injury in the thoracic or lower lumbar spine when using five different types of surgical treatment. There are also no differences in the quality of correction of kyphotic deformity of injured spinal motion segments between all studied groups. Statistically significant lower loss of deformity correction is noted in patients who underwent one-stage circumferential decompression through posterolateral approach and decompression through combined approaches. Notably, operations performed through isolated posterior or anterior approaches have comparable values of correction loss. Operations with decompression of the dural sac through the posterior approaches are characterized by a significantly shorter time of surgical intervention than operations with decompression through the anterior and combined approaches. The smallest volume of blood loss is observed during surgery with decompression through isolated posterior approaches. The largest volume of blood loss is in the group with posterolateral approach and one-stage circumferential decompression. Surgical interventions through posterior approach have a statistically significant lower complication rate than operations that include the anterior stage.
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