Radiological outcomes of percutaneous internal fixation and traditional posterior internal fixation in the treatment of thoracolumbar fracture:a meta-analysis
SUN Xiang-yao
ZHANG Xi-nuo
HAI Yong
Abstract：Objective To systematically review the radiological outcomes of percutaneous internal fixation and traditional posterior internal fixation for thoracolumbar fracture, and to collect better scientific evidence in the treatment of thoracolumbar fracture. Methods The computer retrieve of Pubmed, Cochrane Central Register of Controlled Trails ( CENTRAL ), Embase, CNKI, Wanfang database were performed ( till August, 2016 ). Related journals, the Journal of Bone and Joint Surgery, Spine, European Spine Journal, were manually searched ( till August,2016 ). The included trials were evaluated. Data were independently extracted by two reviewers. The meta-analysis of all the data was carried out using the RevMan 5.3 software. The following indexes were used to compare the results: postoperative Cobb's angle, postoperative Cobb's angle correction loss, postoperative Cobb's angle correction, postoperative vertebral body angle, postoperative VBA ( vertebral body angle ) correction, postoperative VBA correction loss, postoperative VBH% ( vertebral body height% ), postoperative VBH% correction loss. Results Fifteen studies involving 895 patients were included. The levels of included studies were high ( I 3, II 2, III 10 ). The analysis results showed that statistically significant differences were noted between two procedures for the postoperative Cobb's angle correction in 1 week [ MD = -2.03, 95% CI ( -3.41, -0.65 ), P = 0.004 ], postoperative Cobb's angle correction loss after 12 months [ MD = -0.52, 95% CI ( -0.93, -0.11 ), P = 0.01 ]. While no differences were noted for the postoperative Cobb's angle in 6 weeks [ MD = -0.12, 95% CI ( -0.38, 0.61 ), P = 0.65 ], postoperative Cobb's angle in 6 months [ MD = -0.09, 95% CI ( -0.59, 0.42 ), P = 0.13 ], postoperative VBA in 1 week [ MD = 0.21, 95% CI ( -0.69, 1.12 ), P = 0.65 ], postoperative VBA after 12 months [ MD = -0.09, 95% CI ( -1.16, 0.98 ), P = 0.87 ], postoperative VBA correction after 12 months [ MD = -1.72, 95% CI ( -5.13, 1.70 ), P = 0.32 ], postoperative VBA correction loss after 12 months [ MD = -0.42, 95% CI ( -0.96, 0.13 ), P = 0.14 ], postoperative VBH% in 1 week [ MD =-0.17, 95% CI ( -0.37, 0.03 ), P = 0.09 ], postoperative VBH% after 8 months [ MD = -0.41, 95% CI ( -1.01, 0.20 ), P = 0.19 ], postoperative VBH% correction loss [ MD = 0.13, 95% CI ( -1.61, 1.88 ), P = 0.88 ]. Conclusions The postoperative VBA and postoperative VBH% of the two procedures are just similar with each other, which indicates the same vertebral reduction could be achieved by percutaneous internal fixation compared with traditional posterior open internal fixation even though the former provides less reduction force than the latter. Traditional posterior open internal fixation is superior than percutaneous internal fixation in postoperative Cobb's angle correction in 1 week. However, as the follow-up time goes, the differences of Cobb's angle between the two procedures decrease. At the same time, the Cobb's angle correction loss of traditional internal fixation is more severe than percutaneous internal fixation. This indicates the postoperative Cobb's angle correction loss is mainly caused by soft tissue change in the fractured region, which is less related to osseous structures. To sum up, the protection effects percutaneous internal fixation has on soft tissue in the operative region could effectively enhance the long-term postoperative outcomes.
Keywords：Spinal fracturesMinimally invasive surgical proceduresFracture fixationinternalComparative effectiveness researchMeta-analysis
Publication Date：2017-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：9( 596-604 )