| Chapter one:The prevalence of idiopathic scoliosis among primary and middle school students in Mainland China:a systematic review and meta-analysisObjective:To systematic review the the prevalence of idiopathic scoliosis in Mainland China among the primary and middle school students.Methods:We systematically reviewed the published epidemiologic studies or reports on the prevalence of scoliosis in Chinese cities. Scopus, PubMed, WanFang database, CNKI and WeiPu database were searched for studies reporting a prevalence estimate for scoliosis in primary and middle school students with key words:scoliosis, prevalence, incidence or epidemiology. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data and evaluated the methodological quality of the included studies. Meta-analyses were performed to estimate the pooled prevalence of scoliosis by STATA12.0. Subgroup analyses were conducted according to the sex, and age. Results:Based on the search strategy, a total of38papers were eligible for inclusion in this review. The prevalence of scoliosis ranked from0.11%to2.64%. Meta-analyses revealed the prevalence of scoliosis to be1.02%(95%CI,0.85-1.18) among the primary and middle school students in Mainland China. The prevalence of idiopathic scoliosis was0.93%(95%CI,0.72-1.14).The prevalence were0.87%(95%CI,0.72-1.03) and1.22%(95%CI,1.01-1.42) in male and female students respectively. The ratio of female to male was1.54(95%CI,1.35-1.74, P<0.001). According to the subgroup analysis by different Cobb angle(10-20,20-40, more than40), the prevalence of scoliosis were0.74%(95%CI,0.57-0.91),1.33‰(95%CI,1.04-1.61) and0.25‰(95%CI,0.17-0.32) respectively. According to the subgroup analysis by ages, the prevalence of scoliosis increased from0.73%(95%CI,0.55-0.90) to1.14%(95%CI,0.86-1.42).Conclusion:In summary, meta-analyses showed that the prevalence of scoliosis in Mainland China was1.02%among the primary and middle students. The prevalence of idiopathic scoliosis was0.93%. The prevalence of scoliosis in females was higher than in males and the ratio was1.54. As they grew older and the Cobb ange became larger, the prevalence of scoliosis increased in the students. Chapter two:Correlation of gene polymorphism and idiopathic scoliosis susceptibility:a Meta-AnalysisObjective:To evaluate the correlation of gene polymorphism (MTNR1B(Melatonin receptor1B,rs4753426),MATN1(Matrilin-1gene, rs1149048), CHL1(Close Homologue of L1, rs10510181), VDR(Vitamin D Receptor, BsmI), ESR(Estrogen receptor, XbaⅠ and PvuⅡ), IGF1(Insulin-like growth factor1, rs5742612), LBX1(ladybird homeobox homolog1, rs11190870), MMP3(matrix metallopeptidase3, rs3025058) and IL6(Interleukin6, rs1800795)) and idiopathic scoliosis using meta-analysis..Methods:Databases including Scopus, PubMed, WanFang database, CNKI and WeiPu were searched to collect case-control study on the correlation of gene polymorphism and idiopathic scoliosis with key words:gene polymorphism or idiopathic scoliosis. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data. Meta-analysis was performed by STATA12.0and Revman5.1software to estimate the pooled odds ratio (OR) and the95%confidence interval (CI).Results:According to the search strategy,2989papers were initial searched (PubMed:860, Scopus:1482, WanFang:147, CNKI:278and VIP Databse:131). After reading the titles and abstracts,36papers were finally retrieved and were eligible for inclusion in this review. The results of meta-analyses showed that G allele of the rs1149048(OR=1.1295%CI,1.02-1.24) and A allele of the BsmI in VDR gene (OR=1.5795%CI,1.25-1.98) were significantly associated with increased idiopathic scoliosis risk. The T allele of the rs11190870was significantly associated with decreased idiopathic scoliosis risk, which meant that T allele of the rs11190870was a protective role of the idiopathic scoliosis. Subgroup analysis demonstrated that the T allele of the rsl1190870was significantly associated with decreased idiopathic scoliosis risk in female only(OR=0.6195%CI,0.56-0.65), not in male. Neither Egger’s test nor Begg’s test found evidence of publication bias in current study (P>0.05).Conclusion:In summary, meta-analyses showed an overall significant association of rs1149048, rs11190870and BsmI in VDR gene with risk of AIS. The relationship between rs4753426, rs10510181, Xba1and PvuII in ESR, rs5742612, rs3025058and rs1800795are needed to be investigated. Chapter three:Comparative analysis of pedicle screw, hybrid versus hook instrumentation in adolescent idiopathic scoliosis:a network meta-analysis and systematic review.Objective:To evaluate the efficacy of pedicle screw, hybrid versus hook instrumentation in adolescent idiopathic scoliosis by network meta-analysis and systematic review.Methods:Databases including Scopus, PubMed, WanFang database, CNKI and WeiPu were searched to collect clinical studies on the efficacy of pedicle screw, hybrid versus hook instrumentation in adolescent idiopathic scoliosis with key words:pedicle screw, hybrid, hook or idiopathic scoliosis. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data. Meta-analysis was performed by STATA12.0and Revman5.1software to estimate the pooled odds ratio (OR) and the95%confidence interval (CI). Netwrok analysis was conducted by WinBUGS14software and the trial sequential analysis (TSA) was performed by TSA0.9Beta.Results:According to the search strategy,2985papers were initial searched (PubMed:398, Scopus:1796, WanFang:231, CNKI:325and VIP Databse:235). After reading the titles and abstracts,37papers were finally retrieved and were eligible for inclusion in this review. Both direct meta-analysis and network meta-analysis showed that pedicle screw was superior than hybrid and hook instrumentation while the hybrid was superior than hook instrumentation in the improvement of main Cobb angle.Besides main Cobb angle improvement, both direct meta-analysis and network meta-analysis found that pedicle screw was superior than hybrid and hook instrumentation while the hybrid was superior than hook instrumentation in the improvement of translation of the apical vertebra, rotation of the apex vertebral and lowest-instrumented vertebra tilt angle. Both direct meta-analysis and network meta-analysis showed that pedicle screw was less than hybrid and hook instrumentation while the hybrid was less than hook instrumentation in the blood loss and surgery time.Conclusion:1) Pedicle screw was superior than hybrid and hook instrumentation in the improvement of main Cobb angle, translation of the apical vertebra, rotation of the apex vertebral and lowest-instrumented vertebra tilt angle. Pedicle screw was less than hybrid and hook instrumentation in blood loss and surgery time.2) Hybrdi was superior than hook instrumentation in the improvement of main Cobb angle, translation of the apical vertebra, rotation of the apex vertebral and lowest-instrumented vertebra tilt angle while less than hook instrumentation in blood loss and surgery time. |
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