Анализ технических вариантов декомпрессивно-стабилизирующих операций при повреждениях нижнегрудного и поясничного отделов позвоночника: систематический обзор литературы

Цель систематического обзора – анализ клинической эффективности различных технических вариантов хирургического лечения пациентов с повреждениями нижнегрудного и поясничного отделов позвоночника. В обзор включены 57 публикаций за 2001– 2022  гг., отобранных из основных медицинских баз данных PubMed, Medline, The Cochrane Database of Systematic Reviews. В указанных публикациях выделили 5 вариантов выполнения хирургических вмешательств, клиническую эффективность которых анализировали по степени регресса неврологических нарушений, качеству достигаемой репозиции, величине потери коррекции в течение двух лет после операции, количеству осложнений, продолжительности операций и величине кровопотери. Для проведения попарного сравнения между группами использовали критерий Краскела – Уоллиса для нескольких независимых выборок, основанных на первоначальном определении нормальности распределения данных в группах. Для определения различий между параметрами до и после операции использовали критерий Вилкоксона для двух зависимых выборок. Различия признавали статистически значимыми при p < 0,05. Анализ литературных данных показал, что нет различий в динамике неврологического восстановления у больных с позвоночно-спинномозговой травмой в нижнегрудном или поясничном отделе позвоночника при применении пяти различных вариантов хирургического лечения. Также нет различий в качестве коррекции кифотической деформации травмированных позвоночно-двигательных сегментов между всеми изучаемыми группами. Статистически достоверно меньшая величина потери коррекции деформации отмечена у больных, которым выполняли циркулярную одноэтапную декомпрессию из заднебокового доступа и декомпрессию из комбинированных доступов. При этом операции из изолированных задних или передних доступов по этому параметру имеют сопоставимые результаты. Операции с декомпрессией дурального мешка из задних доступов характеризуются достоверно меньшим временем оперативного вмешательства, чем операции с декомпрессией из передних и комбинированных доступов. Наименьший объем кровопотери наблюдается при операциях с декомпрессией из изолированных задних доступов, наибольший объем – в группе с заднебоковым доступом и одноэтапной циркулярной декомпрессией. Оперативные вмешательства с применением заднего доступа статистически достоверно дают меньший процент осложнений, чем операции, включающие вентральный этап.

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