TLIF与PLIF治疗腰椎退行性疾病疗效的Meta分析

Meta-analysis of outcomes of transforaminal lumbar interbody fusion versus posterior lumbar interbody fusion for degenerative lumbar diseases

中文关键词:  经椎间孔腰椎椎体间融合术  后路腰椎椎体间融合术  Meta分析

英文关键词:Transforaminal lumbar interbody fusion  Posterior lumbar interbody fusion  Meta-analysis

中文摘要:

  【摘要】 目的：对TLIF与PLIF治疗腰椎退行性疾病的疗效及并发症进行Meta分析。方法：检索Medline、Ovid、中国生物医学文献数据库系统（CBM）、中国期刊全文数据库（CNKI）、中文科技期刊全文数据库（VIP）等数据库，检索时间至2012年5月。本研究提取的评价指标包括手术时间、手术失血量、住院时间、视觉模拟评分（visual analogue scale，VAS）、Oswestry功能残障指数（Oswestry disability index，ODI）等指标和并发症例数。应用Review Manager 5.1软件进行数据分析。结果：纳入文献9篇，其中随机对照研究1篇，队列研究8篇。共981例，TLIF组457例，PLIF组524例。两组间比较，手术失血量（P=0.002）及住院时间（P=0.02）TLIF组少于PLIF组，而优良例数（P=0.27）、手术时间（P=0.07）、VAS评分（P=0.61）和ODI评分（P=0.24）两组间无差异；总并发症两组间差异显著（P<0.0001），其中神经损伤（P=0.001）、硬膜损伤（P=0.04）TLIF组较少，而脑脊液漏（P=0.25）、螺钉松动（P=0.14）、内固定失败（P=0.86）、未融合例数（P=0.41）和感染（P=0.51）两组间无显著性差异。结论：两者临床总疗效优良率相当，但TLIF手术在手术失血量、住院时间及术后并发症方面，尤其是对神经和硬膜的损伤，较PLIF明显减少。TLIF手术是一种更安全有效地治疗腰椎退行性疾病的方法。

英文摘要:

  【Abstract】 Objectives: To make a Meta-analysis of comparative studies in an attempt to assess clinical outcomes and complication rates after transforaminal lumbar interbody fusion(TLIF) versus posterior lumbar interbody fusion(PLIF) for degenerative lumbar diseases. Methods: By searching Medline, Ovid, CBM, CNKI and VIP, etc, the published articles about studies of TLIF versus PLIF for degenerative lumbar diseases were collected. The data included: operation time, blood loss, hospital stay, visual analogue score(VAS), Oswestry disability index(ODI) and complications. Review Manager 5.1 software was used for data analysis. Results: One randomized controlled trials and eight cohort studies including 981 patients were included in the Meta-analysis(457 patients for TLIF, 524 patients for PLIF). Postoperative outcome(P=0.27), operation time(P=0.07), blood loss(P=0.002), hospital stay(P=0.02) showed better results of TLIF than PLIF, VAS(P=0.61) and ODI(P=0.24) showed no significant difference between two groups; TLIF had less total complications(P<0.0001), nerve injury(P=0.001), dura injury(P=0.04) than PLIF, while cerebrospinal fluid leakage(P=0.25), screw loosening(P=0.14), internal fixation fail(P=0.86), nonunion(P=0.41) and infection(P=0.51) showed no differences between 2 groups. Conclusions: TLIF has similar outcome with PLIF, however, the former has less blood loss, hospital stay and complications rate than the latter, especially for nerve and dura injury, which indicates safety and effectiveness for TLIF.