微创与开放经椎间孔椎体间融合术治疗单节段腰椎病变的Meta分析

Minimally invasive versus open transforaminal lumbar interbody fusion for treatment of one-level lumbar disease: a meta-analysis

中文关键词:  经椎间孔腰椎体间融合术  微创手术  开放手术  单节段  Meta分析

英文关键词:Transforaminal lumbar interbody fusion  Minimally invasive surgery  Open surgery  One-level  Meta-analysis

中文摘要:

  【摘要】 目的：对微创与开放经椎间孔椎体间融合术（TLIF）治疗单节段腰椎病变的临床疗效进行Meta分析。方法：计算机检索PubMed、Web of Science、Cochrane Library、中国生物医学文献数据库、中国知网全文数据库、万方数据库等文献数据库，检索的主题词为“微创（minimally invasive、MIS或mini-open）、开放（open）及经椎间孔椎体间融合术（transforaminal lumbar interbody fusion，TLIF）”，检索时间和语言未作限制。纳入关于微创与开放TLIF治疗单节段腰椎病变的对照研究文献。使用纽卡斯尔-渥太华量表（NOS）来进行文献质量评价与特征描述。利用Review Manager 5.1统计学软件进行数据分析。本研究选择的评价指标包括手术相关性指标（手术时间、术中出血量、术后引流量、术中放射时间、术后卧床时间、住院时间、住院总费用），术后腰痛/下肢痛视觉模拟评分法（VAS），术后Oswestry功能障碍指数（ODI），并发症，翻修手术例数和末次随访融合率。结果：经过筛选共纳入18篇文献，其中5篇前瞻性队列研究，12篇回顾性队列研究，仅1篇随机对照试验，共1437例，微创组691例，开放组746例。质量评价提示纳入文献均属高质量队列研究（NOS评分5~9分）。微创TLIF与开放TLIF比较，前者术中出血量、术后引流量、卧床时间、住院时间、住院总费用均明显少于后者（P＜0.01）；术后3d及末次随访腰痛VAS评分改善优于后者（P＜0.00001）；术中放射时间明显多于后者（P＜0.0001）；在手术时间、并发症发生率、翻修手术率、末次随访融合率、术后下肢痛VAS评分及ODI方面，两者差异均无统计学意义（P＞0.05）。结论：与开放TLIF相比，微创手术创伤小，出血量少，恢复早，术后腰背痛程度较轻的优势，且术后下肢痛的改善及并发症发生率相当，但术中放射时间较长。

英文摘要:

  【Abstract】 Objectives: This is a meta-analysis to compare the clinical results between minimally invasive and open transforaminal lumbar interbody fusion (TLIF) for one-level lumbar disease. Methods: Studies were identified from PubMed, Web of Science, Cochrane Library, China Biological Medicine Database, China National Knowledge Infrastructure and Wanfang Database, by using the keywords "minimally invasive, MIS or mini-open", "open" and "transforaminal lumbar interbody fusion". The published studies with no language and year restrictions were included. Only studies comparing minimally invasive and open TLIF for the treatment of one-level lumbar disease were included. The Newcastle-Ottawa Scale(NOS) was used to evaluate the risk of bias of the included studies. All data were analyzed by Review Manager 5.1. The outcomes were surgery related indexes(operation time, blood loss, postoperative drainage, intraoperative radiation time, bedridden time, hospital stay and hospital expenses), visual analogue score(VAS) of postoperative back pain and leg pain, postoperative Oswestry Disability Index(ODI), complications, reoperation rate and fusion rate. Results: Eighteen studies(five prospective cohort studies, twelve retrospective cohort studies, only one randomized controlled trial) with 1437 patients were included in this meta-analysis(691 patients for minimally invasive group, 746 patients for open group). Quality evaluation indicated that all of included studies were high quality cohort studies(NOS range: 5-9). The blood loss(P＜0.00001), postoperative drainage(P＜0.003), bedridden time (P=0.002), hospital stay(P＜0.00001), hospital expenses (P=0.0008), VAS of back pain at 3 days after surgery and the final follow-up(P＜0.00001) were significantly lower in minimally invasive group than those in open group; intraoperative radiation time in minimally invasive group was significantly higher(P＜0.0001); there were no significant differences between minimally invasive and open group in operation time, complications, reoperation rate, fusion rate, VAS of leg pain and ODI(P＞0.05). Conclusions: Compared with traditional open surgery, minimally invasive transforaminal lumbar interbody fusion reduces blood loss, allows early postoperative recovery, relieves postoperative back pain, and increases intraoperative radiation time, while achieves comparable postoperative leg pain improvement and complication rates.