摘要
目的系统评价后外侧融合(posterolateral fusion,PLF)与后路椎体间融合(posterior lumbar interbody fusion,PLIF)治疗腰椎滑脱的临床疗效,为腰椎滑脱的治疗提供更好的科学依据。方法计算机检索Medline、Embase、Cochrane Central Register of Controlled Trial数据库,结合手工检索专业相关杂志。纳入腰椎滑脱治疗中对比PLF和PLIF的随机对照试验(randomized controlled trials,RCTs)和比较性研究。依据Furlan标准评估评价纳入RCT的方法学质量,依据Cowley标准评估观察性研究的方法学质量,采用RevMan5.0软件对所得数据进行Meta分析,使用GRADE法评估所得结论的证据等级。结果经过系统检索和筛检,共纳入4篇随机对照试验和5篇观察性研究,共520例。分析结果显示:PLIF的术后满意度86.7%高于PLF 76.6%(OR:0.49,95%CI:0.28,0.88,P=0.02)。两种融合方式的并发症发生率差异无统计学意义(OR:2.28,95%CI:0.97,5.35,P=0.06)。PLIF的融合率92.5%高于PLF 79.6%(OR:0.32,95%CI:0.17,0.61,P=0.0006),再手术率PLIF 3.6%低于PLF 17.3%(OR:5.30,95%CI:1.47,19.11,P=0.01),出血量和手术时间差异无统计学意义(WMD=76.52,95%CI:-310.68,463.73,P=0.70);(WMD=-1.20,95%CI:-40.36,37.97,P=0.95)。结论 PLIF较PLF可以更好地提高腰椎滑脱患者术后满意度、缓解术后疼痛、增加其融合率、降低再手术率,两者的术后功能状态的改善、并发症发生率、手术时间和失血量无差异。
Objective To systematically review the clinical results of posterolateral fusion （ PLF ） and posterior lumbar interbody fusion （ PLIF ） for lumbar spondylolisthesis, and to collect better scientific evidence in the treatment of lumbar spondylolisthesis. Methods The computer retrieval of Medline, Embase and Cochrane Central Register of Controlled Trials （ CENTRAL ） was performed, and related journals were manually searched. The randomized controlled trials （ RCTs ） and comparative studies were performed to analyze the clinical results of PLF and PLIF in the treatment of lumbar spondylolisthesis. The methodological quality included in the RCT was evaluated according to the Furlan standard, and the methodological quality of observational studies was evaluated by the Cowley standard. The meta-analysis of all the data was carried out using the RevMan5.0 software. The levels of evidence of the clinical results were evaluated by the Grades of Recommendation, Assessment, Development, and Evaluation （ GRADE ） Working Group. Results Through systematic retrieval and screening, 4 RCTs and 5 pieces of observational studies were identified, with 520 patients in all. The analysis results showed that patients were more satisfied after PLIF 86.7% than those after PLF 76.6% （ OR： 0.49, 95% CI： 0.28, 0.88, P=-0.02 ）, and no significant differences were found in the complication rate （ OR： 2.28, 95% CI： 0.97, 5.35, P=0.06 ）. In addition, the fusion rate of PLIF 92.5% was higher than that of PLF 79.6% （ OR： 0.32, 95% CI： 0.17, 0.61, P=0.0006 ）, and the reoperation rate of PLIF 3.6% was lower than that of PLF 17.3% （ OR： 5.30, 95% CI： 1.47, 19.11, P=-0.01 ）. No statistically significant differences were found between the 2 groups with regard to the blood loss （ Weighted Mean Difference WMD=76.52, 95% CI： -310.68, 463.73, P=-0.70 ） and operation time （ WMD=-I.20, 95% CI： -40.36, 37.97, P=-0.95 ）. Conclusions PLIF can better improve patient satisfaction, relieve postoperative pain, increase the fusion rate and reduce the reoperation rate when compared with PLF. No differences are found between the 2 fusion methods in terms of improvement in the fimctional status, complication rate, operation time and blood loss in the treatment of lumbar spondylolisthesis.
出处
《中国骨与关节杂志》
CAS
2013年第10期556-562,共7页
Chinese Journal of Bone and Joint
关键词
脊椎滑脱
META分析
腰椎
Spondylolysis
Meta-analysis
Lumbar vertebrae
