Comparison of clinical efficacy of complete and incomplete radical debridement for spinal tuberculosis: a Meta-analysis / 中国骨伤

ABSTRACT

<p><b>OBJECTIVE</b>To compare clinical efficacy of complete and incomplete radical debridement for spinal tuberculosis by Meta-analysis.</p><p><b>METHODS</b>The literatures of RCT or non-RCT with complete and incomplete radical debridement for spinal tuberculosis from Medline, EMBASE, Cochrane Library, Web of Science, CBM, CNKI and Wanfang were searched from the time of creating database to July, 2017. Two independent reviewers identified eligible studies, extracted data and evaluated risk of bias of included studies. Meta analysis were performed by Revman 5.3 and GRADE system were used to grade evidence. Recurrence rate, adverse effects, healing time, chemotherapy duration, spinal deformity by correction angle, bone fusion time in interface of intervertebral, erythrocyte sedimentation rate and C-reaction protein were compared between two groups.</p><p><b>RESULTS</b>Totally 9 literatures were chosen, including 5 RCT and 4 non-RCT with 1 302 patients. Compared with incomplete radical debridement, complete radical debridement had lower recurrence rate [=0.14, 95%CI(0.08, 0.22), <0.000 01], lower rate of adverse effects[=0.18, 95%CI(0.12, 0.27), <0.000 01], shorter healing time[MD=-4.80, 95%CI(-5.14, -4.45), <0.000 01]and chemotherapy duration [MD=-5.25, 95%CI(-5.64, -4.86), <0.000 01], larger spinal deformity by correction angle[MD=4.88, 95%CI(3.55, 6.27), <0.000 01], smaller erythrocyte sedimentation rate[MD=-8.74, 95%CI(-11.99, -5.49), <0.000 01] and C-reaction protein [MD=-4.75, 95%CI(-8.61, -0.88), =0.02] . However, there was no difference on bone fusion time in interface of intervertebral between two groups[MD=-0.19, 95%CI(-0.50, 0.12), =0.23].</p><p><b>CONCLUSIONS</b>Compared with incomplete radical debridement, complete radical debridement has advantages of lower incidence of recurrence, lower rate of adverse reaction, shorten healing time and chemotherapy time, recovered faster. Techniques are selected according to indication of patients individual, complete radical debridement is recommended at the same indications.</p>