A Network Meta-analysis Of The Efficacy And Safety Of Different Surgical Techniques For Thoracolumbar Fractures

Background:The surgical techniques for the single-level thoracolumbar fractures include posterior open long-segment fixation,shor-segment fixation and minimal invasive short-segment fixation.Although LF could have better reduction and more strength,it will lose more movements.SF could retain more movements,but the prevalence of the broken of the instrumentation and the loss of correction is higher.SFWF could compensate the shortcomings of SF.Some studys have shown that the additional screws in the fractured level could not only provide better reduction and more strength,but also retain more movements.With the development of minimal invasive techniques,both percutaneous and Wiltse approach have the advantages of less trauma and blood loss,whereas the early reduction is insufficient.Minimal techniques with additional screws in the fractured level could have more satisfactory clinical effects and less trauma.There are some systematic reviews on the surgical techniques of thoracolumbar fractures,most of them are pairwised meta-analysis with inconsistent conclusion that are mainly compared three groups:SF versu PSF,SF versu SFWF,WSF versu SF.And the best surgical technique for thoracolumbar fractures is still unclear.Thus,we reckon it is necessary to compare the clinical effects of variety of different surgical techniques for thoracolumbar fractures so thar we can conduct a more comprehensive analysis through network meta-analysis.We particularly hope to draw the comparison of the two minimal invasive techniques:Percutaneous and Wiltse approach,and determine which is best according to the comparison of different techniques.Objective:To compare the efficacy and safety of different surgical techniques in the treatment of single-level thoracolumbar fractures through the method of network meta-analysis,and to provide more comprehensive evidencebased medicine for clinical practice.Methods:Computer searched PubMed,Embase,Web of Science,Scopus,Cochrane,Wanfang,CNKI and VIP databases,searched randomized controlled trials and case-control trials,screened according to pre-set inclusion and exclusion criteria,and evaluated the quality of the final included literature Afterwards,perform network meta-analysis through R software,Stata software,etc.Results:A total of 52 articles were included with 3392 patients,and 6 surgical techniques were compared,including simple short-segment fixation,shortsegment fixation with injured vertebra,percutaneous short-segment fixation,and percutaneous short-segment fixation with injured vertebra,short-segment fixation via the Wiltse approach,and short-segment fixation with injured vertebra via the Wiltse approach.The evaluation outcomes include: Cobb Angle immediately after surgery,Cobb angle at the last follow-up,AVH% of the injured vertebra immediately after surgery,AVH%of the injured vertebra at the last follow-up,blood loss,duration of operation,incision length,and VAS score at the last follow-up.The results of the network meta-analysis showed the technique that the short-segment fixation with injured vertebra via the Wiltse approach had the best effect in Cobb Angle immediately after surgery,Cobb angle at the last follow-up,AVH% of the injured vertebra immediately after surgery,AVH% of the injured vertebra at the last follow-up,and the VAS score at the last followup;the short-segment fixation via the Wiltse approach has the shortest duration of operation and the percutaneous short-segment fixation technique has the best effect in the comparison of blood-lossing and incision length.Conclusion:The short-segment fixation with injured vertebra via the Wiltse approachhas a significant effect on the correction of the Cobb angle and the AVH% of the injured vertebrae immediately after the operation.Maintenance also has an excellent clinical effect,while the pain relief is better;the operation time of the short-segment fixation via the Wiltse approach is relatively short and the advantages of the percutaneous shortsegment fixation technique are more reflected in the less trauma and less bleeding.Due to the limited quality of the literature included in this study,the conclusions drawn will still need to be demonstrated by higher-quality randomized controlled trials in the future.