Objective

Posterior short-segment fixation (4-screw construct = 4S) is the conventional surgical technique for thoracolumbar fractures. The effect of adding two intermediate pedicle screws at the fractured level (6-screw construct = 6S) is still a matter of debate. This review aims to compare the results between 4 and 6S pedicle screw fixation for thoracolumbar fractures.

Methods

A systematic review and meta-analysis were performed. The databases PubMed, Embase and Google Scholar were searched until January 2020. Inclusion criteria were studies comparing 4S and 6S techniques in patients with thoracolumbar fractures. Non-comparative studies and studies without full text were excluded. Cochrane risk of bias was assessed, and the GRADE approach was used to present the quality of evidence.

Results

Twenty-seven studies, of which 21 randomized controlled trials, with a total of 1890 patients (940 with 4S and 950 with 6S) were included. Meta-analysis showed that the 6S technique resulted in significantly lower pain scores, better short-term and long-term Cobb angles, less loss of correction and less implant failures. However, longer operation time and more blood loss were seen with the 6S technique. Length of hospital stay, Oswestry Disability Index scores and infections did not differ significantly between the 6S and 4S techniques. Quality of the evidence according to GRADE was moderate to low.

Conclusion

In the treatment of thoracolumbar fractures, adding intermediate screws at the fracture level (6S) results in less post-operative pain, better radiological outcomes and less implant failure at the cost of a longer operation time and higher blood loss.

中文翻译：

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胸腰椎骨折椎弓根螺钉固定术：骨折水平的常规短节段与短节段中间螺钉的系统评价和荟萃分析。

客观的

后路短节段固定（4 螺钉结构 = 4S）是胸腰椎骨折的常规手术技术。在骨折水平添加两个中间椎弓根螺钉（6 螺钉结构 = 6S）的效果仍然存在争议。本综述旨在比较 4 和 6S 椎弓根螺钉固定治疗胸腰椎骨折的结果。

方法

进行了系统评价和荟萃分析。数据库 PubMed、Embase 和 Google Scholar 的搜索截止日期为 2020 年 1 月。纳入标准是比较 4S 和 6S 技术治疗胸腰椎骨折患者的研究。非比较研究和没有全文的研究被排除在外。评估了 Cochrane 偏倚风险，并使用 GRADE 方法来呈现证据质量。

结果

共纳入27项研究，其中21项随机对照试验，共1890名患者（4S患者940人，6S患者950人）。荟萃分析表明，6S 技术显着降低了疼痛评分，更好的短期和长期 Cobb 角，更少的矫正损失和更少的植入失败。然而，使用 6S 技术可以看到更长的手术时间和更多的失血量。住院时间、Oswestry 残疾指数评分和感染在 6S 和 4S 技术之间没有显着差异。根据 GRADE 的证据质量为中到低。

结论

在胸腰椎骨折的治疗中，在骨折水平（6S）处添加中间螺钉可以减少术后疼痛，更好的放射学结果和更少的植入失败，但代价是更长的手术时间和更多的失血量。