Meta-analysis Of Minimally Invasive Percutaneous And Traditional Open Pedicle Screw Fixation For Thoracolumbar Fractures

Background The primary goal of treatment for thoracolumbar vertebral fractures is to stabilize the injured area and promote vertebral healing or segmental fusion.With the development of science and technology,percutaneous pedicle screw internal fixation has gradually developed into one of the main methods for the treatment of thoracolumbar vertebral fractures,aiming to reduce the damage to soft tissue and the incidence of perioperative period.We compared the efficacy of percutaneous pedicle screw and open pedicle screw in the treatment of thoracolumbar fractures by meta-analysis.Objective Meta-analysis is performed to evaluate the difference in the efficacy of percutaneous pedicle screw and open pedicle screw in the treatment of thoracolumbar fractures,and to evaluate the advantages and disadvantages of the two surgical methods.Methods A randomized controlled trial comparing the efficacy of percutaneous pedicle screw and open pedicle screw in the treatment of thoracolumbar fractures and a retrospective cohort study published to December 2017 was conducted by searching Chinese databases such as CNKI,WanFang and VIP,and foreign language databases such as Pubmed,Medline,Cochrane Databases and Embase,to compare the operative time,intraoperative blood loss,postoperative hospitalization time,postoperative screw dislocation rate,postoperative infection rate,postoperative VAS score,postoperative operative segment Cobb angle,postoperative fracture vertebra self Cobb angle and postoperative vertebral body anterior margin height of the two surgical methods.Literature screening,data extraction and literature qualityassessment were performed by two reviewers alone,and RevMan5.3.5 software is used for meta-analysis.Results A total of 12 articles were included.A total of 340 patients underwent percutaneous pedicle screw surgery for thoracolumbar fractures,compared with 340 patients who underwent conventional open pedicle screw surgery.Compared with traditional open surgery,percutaneous pedicle screw treatment for thoracolumbar vertebral fracture shorted the operation time by about 19 minutes(P=0.0002)and the length of hospital stay,percutaneous pedicle screw treatment for thoracolumbar vertebral fracture was 5.7 days earlier than traditional open surgery(P=0.0007).At the same time,there was no significant difference in postoperative screw dislocation rate between the two surgical methods(RR,0.76;95% CI,(0.35,1.66);P = 0.50),but in terms of postoperative infection rate,percutaneous pedicle screw fixation was lower(RR,0.36;95% CI(0.13,1.00);P = 0.05)and performed better in postoperative VAS score(P=0.001).However,in the postoperative operative segment Cobb angle(P=0.22),postoperative fracture vertebra self Cobb angle(P=0.66)and postoperative vertebral body anterior margin height(P=0.19),we did not find significant differences between percutaneous pedicle screw surgery and traditional open surgery.Conclusion The operative time and hospitalization time of percutaneous pedicle screw fixation were shorter,and the intraoperative blood loss and postoperative infection rate were also lower.Due to the lack of reliable clinical studies,these results need to be confirmed in a large number of prospective studies and randomized trials.