摘要
背景:大量研究已证实微小切口与开放经椎间孔腰椎椎间融合治疗单节段和多节段腰椎退行性疾病均有较好的疗效,但两种治疗方法的优劣目前尚无定论。目的:系统评价微小切口与开放经椎间孔腰椎椎间融合治疗腰椎退行性疾病的疗效及安全性。方法:计算机检索The Cochrane Library(2014年第2期)、PubMed、EMbase、MEDLINE、SCI、CNKI、CBM、WanFang Data,检索时限为到2014年2月;收集采用微小切口与开放经椎间孔腰椎椎间融合治疗腰椎退行性疾病的随机或非随机同期对照试验。由2名评价者按照纳入与排除标准选择试验、提取资料和评价质量后,采用RevMan 5.2软件进行Meta分析。结果与结论:纳入1个随机对照试验,18个非随机对照试验,共1 400例患者。Meta分析结果显示,与传统开放经椎间孔腰椎椎间融合相比,微小切口经椎间孔腰椎椎间融合具有椎旁肌损伤小,出血量少,住院时间短,早期疗效好,腰痛远期缓解率高等优点;但是微小切口经椎间孔腰椎椎间融合在改善远期运动功能,远期腿痛缓解率,减少并发症方面并不优于开放经椎间孔腰椎椎间融合治疗;且手术时间更长。因此,在严格掌握适应证的前提下,采用微小切口经椎间孔腰椎椎间融合能较好解决腰椎退行性疾病患者的病痛。由于纳入研究数量和质量存在局限性,上述结论仍需大样本、高质量的随机对照试验进一步验证。临床应根据患者的具体情况,综合评估病情,选择最佳治疗方案。
BACKGROUND： A large number of studies have confirmed that minimally invasive and open transforaminal lumbar interbody fusion approaches for single-segment and multi-segment lumbar degenerative diseases were effective, but their advantages and disadvantages remain inconclusive. OBJECTIVE： To systematically evaluate the effectiveness and safety of minimally invasive versus open transforaminal lumbar interbody fusion for lumbar degenerative disease. METHODS： Databases including The Cochrane Library（Issue 2, 2014）, PubMed, EMbase, MEDLINE, SCI, CNKI, CBM, Wanfang Data were searched to collect the randomized controlled trails and non-randomized controlled trails about minimally invasive and open transforaminal lumbar interbody fusion for lumbar degenerative disease. The retrieval time was from foundation to February 2014. The studies were screened according to inclusion and exclusion criteria. The data were extracted and the quality was evaluated by two reviewers independently. Meta-analysis was conducted using RevMan 5.2 software. RESULTS AND CONCLUSION： A total of 1 randomized controlled trail and 18 non-randomized controlled trails involving 1 400 patients were included. The results of meta-analysis showed that： compared with open transforaminal lumbar interbody fusion, minimally invasive transforaminal lumbar interbody fusion had many advantages, such as small paraspinal muscle injury, less blood loss, short hospital stay, good early effects and high long-period remission rate of lumbago. However, minimally invasive transforaminal lumbar interbody fusion was not superior to open transforaminal lumbar interbody fusion in improving long-period motor function, long-term remission rate of leg pain and in reducing complications. Moreover, the operation time of minimally invasive transforaminal lumbar interbody fusion was longer. Therefore, under the premise of strict indications, minimally invasive transforaminal lumbar interbody fusion could better solve the complaint of patients with lumbar degenerative disease. For the quantitative and qualitative limitation of the included studies, this conclusion still requires to be further proved by performing a larger scale and a higher quality of randomized controlled trails. It suggests that doctors should choose a best therapy for patients according to an integrative disease assessment.
出处
《中国组织工程研究》
CAS
CSCD
2014年第22期3542-3550,共9页
Chinese Journal of Tissue Engineering Research
