Comparison Of The Clinical Efficacy Of Pedicular Screw Fixation On Or Across The Fractured Vertebra To Treat Thoracolumbar Fractures:a Meta-analysis

Thoracolumbar fracture, one of the most common spinal traumas,generally refers to spinal fractures between the12th thoracic vertebra to thesecond lumbar vertebra, and about half of the spinal fractures occur at thislevel. Thoracolumbar segment works as the turning point of the thoracickyphosis and lumbar lordosis. It is under the thoracic vertebra with smallrange of motion and upon the lumbar vertebra with big range of motion. Thisis the key body part to bear most of the weight from shoulder and back, andthe stress arising from the trunk motions. Therefore, the incidence ofthoracolumbar fractures is relatively high. Thoracolumbar fractures are oftenaccompanied by varying degrees of spinal cord injuries which may lead tocorresponding clinical symptoms and signs. It may also be associated withlung infections, urinary tract infections, pressure ulcers, deep vein thrombosisand other long-term complications. Therefore, it is significant to accuratelyidentify the mechanism of injuries and fractures types, and timely formulateappropriate effective treatment programs so as to reduce short-term andlong-term complications and improve the prognosis.Objective: The objective of the study is to provide the theoretical basisfor the appropriate selection of surgical approaches in the clinical treatment ofthoracolumbar fractures by researching and analyzing literatures relating to thecomparison of the clinical efficacy of pedicular screw fixation on or across thefractured vertebra to treat thoracolumbar fracture in the past20years;appraising the quality of literatures in detail; comprehensively evaluating theclinical efficacy of pedicular screw fixation on or across the fractured vertebrato treat thoracolumbar fractures with relevant criteria. Methods: Firstly using computer to research and collect literatures thatinvestigate and compare the clinical effect of pedicular screw fixation on oracross the fractured vertebra to treat thoracolumbar fractures which arepublished in Medline (international comprehensive bibliographic database ofbiomedical information), EMBASE (Netherlands EMBASE databases), OVID(Ovid databases), GOOGLE SCHOLAR and other authoritative foreignlanguage databases, and the Chinese databases including Chinese Journal ofNetwork and database (CNKI), Chinese Scientific Journals Full-text Database(Chinese periodical full text database of science and technology), VIP,Articles China Conference Papers (CACP), Articles Chinese dissertationdatabase (CDDB) etc. in the past20years; Secondly,determining the finalincluded literatures through assessing the methodological quality of allretrieved literatures by two reviewers in strict accordance with the establishedliterature inclusion and exclusion standards independently; The last step issorting and analyzing the data from the final included literatures, finally usingRevMan5.0software provided by Cochrane collaboration for the statisticalanalysis of the data,and getting the result of meta-analysis.Results: Totally six literatures, comprising three English literatures andthree Chinese literatures, have reached the established literature inclusion andexclusion standards and have been included. Five of them are retrospective;one of them is prospective; three of them are randomized control trial. In all,there are314patients, of which158patients were treated with fixation onfractured vertebra and156patients were treated with fixation across thefractured vertebra. After methodologically assessing the quality of thoseliteratures, the results demonstrate that four of the five retrospective literaturesare in high quality; one is in low quality; one prospective literature is in highquality. The result of Meta-analysis demonstrates that there is no significantdiscrepancy in the recovery of the anterior flange height and the correction ofkyphotic deformity (Cobb angle) one week after the operation of pedicularscrew fixation on or across the fractured vertebra. However, the two groupshave significant discrepancy in both the recovery of the anterior flange height and the correction of kyphotic deformity (Cobb angle) in the last visit afteroperation, and the group with the fixation on the fractured vertebra was muchbetter than the group with the fixation across the fractured vertebra.Conclusion: The method of pedicular screw fixation on the fracturedvertebra to treat thoracolumbar fracture can effectively enhance the stability offixation and correct kyphotic deformity. Therefore, according to clinicalsurgical indications, it is an effective operational method to treatthoracolumbar fracture using the method of pedicular screw fixation on thefractured vertebra.