A Systematic-analysis Of Transpedicular Intracorporeal Grafting For Thoracolumbar And Lumbar Fractures

Objective:to assess the effect of preventing kyphosis and hardware failure by combining transpedicular intracorporeal grafting for thoracolumbar and lumbar fractures.Methods:We have searched MEDLINE,EMBASE and other electronic databases for articles published between 1995.1-2010.1 that satisfied inclusion and exclusion criteria, have analysed the hardware failure rate and influence factors(such as correction loss, status of nerve system, levels of fractured vertebrea, sex distribution). According to the 3 kinds of measurement of correction loss, we measured the kyphosis of pre-postoperation of 37 patients who were admitted to orthopeadic department of Zhongshan Hospital because of thoracolumbar fractures, convert the measurement method of correction angel (sagittal index & regional index to vertebral kyphosis) by linear correlation. The outcome of correction loss was pooled as continuous variable; the outcome of hardware failure rate, correction loss, status of nerve system, levels of fractured vertebrea, sex distribution were pooled as classification variables. Outcomes were pooled by random-effects. Meta-analysis and Meta-regression analysis was used to control for average age,level of vertebrae presence ofintra-articular fracture,duration of follow-up period,and postoperation neurologic state.Result: First we identified 543 paper on comparison of posterolateral fusion compared with combining transpedicular intracorporeal grafting in patients with thoracolumbar fractures.32 trials, involving 1124 patients, were identified as meeting all the eligibility criteria.32 trials, involving 1124 patient, provided information on internal fixation failure and proved posterolateral fusion combining intracorporeal grafting could reduce internal fixation failure.26 trials, involving 720 patients, showed that the correction loss (consisting of mean and standard deviation) was not detected any statistical significant differences during the follow-up period(1.5-3y) between the two groups.15 reseaches showed internal fixation failure rate was higher in some researches which had more patients of poor neurologic state. There were no statistical significant differences in tatus of nerve system, levels of fractured vertebrea, sex distribution.Conclution:Compared to posteriolateral fusion, combining intracorporeal grafting proved better to prevent hardware failure ater posterior stabilization of thoracolumbar and lumbar fractures. Because the limitation of the quality and amount of paper, It is hard to judge which is the better choice between the two methods. Although internal fixation failure rate is higher in the team, there are not significant different between the two team. It will need further reseach in multicentre, large amount, controled tests...