经椎间孔椎体间融合术与经后路椎体间融合术治疗轻、中度退变性腰椎滑脱症临床疗效及安全的Meta分析

A Meta-analysis: clinical efficacy and safety of TLIF versus PLIF for the treatment of mild-moderate degenerative lumbar spondylolisthesis

中文关键词:  腰椎融合  经椎间孔椎体间融合术  经后路椎体间融合术  腰椎滑脱  Meta分析

英文关键词:Lumbar fusion  Transforaminal lumbar interbody fusion(TLIF)  Posterior lumbar interbody fusion(PLIF)  Lumbar spondylolisthesis  Meta-analysis

中文摘要:

  【摘要】 目的：应用Meta分析综合评价经椎间孔椎体间融合术（transforaminal lumbar interbody fusion，TLIF）与经后路椎体间融合术（posterior lumbar interbody fusion，PLIF）治疗退变性腰椎滑脱症的临床疗效和安全性，为临床决策提供参考依据。方法：计算机检索中国期刊全文数据库（China national knowledge infrastructure，CNKI）、中国生物医学文献数据库（China biology medicine，CBM）、万方数据库（Wanfang Database）、PubMed、The Cochrane Library、Elsevier ScienceDirect（SDOS）数据库中关于TLIF与PLIF治疗退变性腰椎滑脱症的文献，检索时限均是从各数据库建库时间至2017年8月。纳入文献包含以下参考指标中的两项以上：手术时间、术中出血量、融合例数、视觉模拟评分（visual analogue scale，VAS）、Oswestry功能残障指数（Oswestry disability index，ODI）、手术并发症例数、末次随访椎间高度、再手术例数。使用Cochrane Library提供的RevMan 5.3软件进行Meta分析。结果：共纳入2篇随机对照研究，8篇队列研究。共纳入患者757例，其中TLIF组386例，PLIF组371例。两组在手术时间、术中出血量、并发症例数方面，TLIF组均少于PLIF组，差异有统计学差异（P<0.05）。两组在VAS评分、ODI评分、融合例数、恢复椎间高度、再手术例数方面，差异无统计学意义（P＞0.05）。结论：两种椎间融合方式在术后VAS评分、ODI评分、融合例数、恢复椎间高度方面无显著性差异，临床疗效相当。TLIF在手术时间、术中出血量、总体并发症例数方面均少于PLIF，其安全性较高。

英文摘要:

  【Abstract】 Objectives: Comprehensive evaluation of the clinical efficacy and safety of transforaminal lumbar interbody fusion(TLIF) and posterior lumbar interbody fusion with pedide(PLIF) screw fixation for the treatment of degenerative lumbar spondylollsthesis(DLS), to provide evidence for clinical procedure. Methods: Databases including CNKI, CBM, Wanfang Database, PubMed, the Cochrane Library, Elsevier ScienceDirect(SDOS) were searched for studies of TLIF versus PLIF for degenerative lumbar spondylolisthesis from the inception respectively to August 2017. Included studies contain at least the following indicators: operation time, intraoperative blood loss, fusions, visual analogue score(VAS), Oswestry disability index(ODI), complications, disc space height, reoperations. Review Manager 5.3 software was used for data analysis. Results: Two randomized controlled trials(RCT) and eight cohort studies including 757 patients were included in the meta-analysis: 386 patients in TLIF group, 371 patients in PLIF group. The results of meta-analysis showed that there were statistical differences in operation time(P<0.05), intraoperative blood loss(P<0.05) and complications(P<0.05) between two groups. There were no statistical differences in VAS(P=0.18), ODI(P=0.27), fusions(P=0.80), disc space height(P=0.97) and reoperations(P=0.29). Conclusion: Two different methods have no statistical difference in VAS, ODI, fusions, disc space height. They have similar clinical efficacy. And, TLIF have less operation time, intraoperative blood loss, and complications than PLIF, TLIF safer than PLIF.