单侧椎弓根螺钉联合对侧经椎板关节突螺钉内固定与双侧椎弓根螺钉内固定治疗腰椎退行性疾病疗效的Meta分析

A Meta-analysis of unilateral pedicle screw plus contralateral translaminar facet screw and bilateral pedicle screw internal fixation for lumbar degenerative disease

中文关键词:  腰椎退行性疾病  经椎板关节突螺钉  椎弓根螺钉  内固定  Meta分析

英文关键词:Degenerative disease of the lumbar spine  Translaminar facet screws  Pedicle screws  Internal fixation  Meta-analysis

中文摘要:

  【摘要】 目的：通过Meta分析评价后路减压融合单侧椎弓根螺钉联合对侧经椎板关节突螺钉（unilateral pedicle screws plus contralateral translaminar facet screws，UPSFS）内固定与双侧椎弓根螺钉（bilateral pedicle screws，BPS）内固定治疗腰椎退行性疾病的疗效。方法：检索PubMed、Cochrane、Embase、CNKI、万方、维普数据库自建库至2021年1月发表的关于后路减压融合UPSFS内固定与BPS内固定治疗腰椎退行性疾病的病例对照研究，按照纳入排除标准进行文献筛选，采用纽卡斯尔-渥太华量表（Newcastle-Ottawa scale，NOS）对纳入研究进行质量评价，提取纳入研究结局指标数据，包括术前与末次随访腰痛和腿痛视觉模拟评分（visual analogue scale，VAS）、日本骨科协会（JOA）评分、Owestry功能障碍指数（ODI）、手术节段椎间隙高度的改变值，手术切口长度、手术时间、术中出血量、术后引流量、住院费用，末次随访时手术节段融合率以及并发症发生率，提取数据后通过Review Manager 5.3软件进行Meta分析。结果：共纳入10篇文献，所有研究NOS评价均符合要求。总计有588例患者接受了内固定手术，其中UPSFS固定291例，BPS固定297例，随访时间12~60个月。Meta分析结果显示，术前与末次随访时腿痛VAS评分改变值[加权均数差（weighted mean difference，WMD）=-0.30，95%置信区间（confidence interval，CI）（-0.57，-0.03）]、切口长度[WMD=-4.49，95%CI（-6.64，2.55）]、手术时间[WMD= -32.61，95%CI（-45.23，19.99）]、术中出血量[WMD=-152.63，95%CI（-208.91，-96.35）]、术后引流量[WMD= -186.21，95%CI（-286.06，-86.36）]以及住院费用[WMD=-1.68，95%CI（-2.27，-1.10）]，两组具有显著性差异，UPSFS组优于BPS组（P＜0.05）；而术前与末次随访腰痛VAS评分[WMD=-0.00，95%CI（-0.26，0.27）]、JOA评分[WMD=0.26，95%CI（-1.59，2.11）]、ODI[WMD=0.26，95%CI（-1.59，2.11）]、手术节段椎间隙高度[WMD=0.01，95%CI（-0.61，0.63）]的改变值，末次随访时的融合率[OR=0.31，95%CI（0.10，1.03）]以及并发症发生率[OR=1.43，95%CI（0.60，3.40）]，两组之间均无显著性差异（P＞0.05）。结论：在后路减压融合手术治疗腰椎退行性疾病时，UPSFS固定具有和BPS固定相当的临床疗效和安全性，且前者对患者腿痛程度的改善更加显著，同时可以缩小手术切口，减少手术时间、术中出血量、术后引流量以及住院费用。

英文摘要:

  【Abstract】 Objectives: To evaluate the efficacy of posterior decompression and fusion with unilateral pedicle screw plus contralateral translaminar facet screw(UPSFS) and bilateral pedicle screw(BPS) internal fixation for lumbar degenerative disease by a Meta-analysis system. Methods： Case-control studies about the treatment of lumbar degenerative diseases with UPSFS and BPS published on PubMed, Cochrane, Embase, CNKI, Wanfang and VIP databases from their establishment to January 2021 were searched. Literature screening was conducted according to inclusion and exclusion criteria. The Newcastle-Ottawa scale(NOS) was used to evaluate the quality of the included studies. Outcome index data were extracted, including pre-operative and the final follow-up scores of visual analogue scale(VAS)(low back and leg), Japanese Orthopaedic Association(JOA) scores, Oswestry disability index(ODI), and changes of intervertebral space height of the surgical segment, as well as the length of surgical incision, operative time, intraoperative blood loss, postoperative drainage volume, hospitalization cost, operative segmental fusion rate and complication rate. Meta-analysis was performed by Review Manager 5.3 after data collection. Results: Ten case-control studies were included, and all of them met the requirements for NOS evaluation. A total of 588 patients underwent internal fixation, including 291 patients in the intervention group(UPSFS internal fixation) and 297 in the control group(BPS internal fixation). Follow-up period ranged from 12 to 60 months. Results of Meta-analysis showed that there were significant differences between the two groups in VAS(leg) changes from baseline to the final follow-up [weighted mean difference(WMD)=-0.30, 95% confidence interval(CI)（-0.57, -0.03）], incision length [WMD=-4.49, 95%CI(-6.64, 2.55)], operative time[WMD=-32.61, 95%CI(-45.23, 19.99)], intraoperative blood loss[WMD=-152.63, 95%CI(-208.91, -96.35)], postoperative drainage volume[WMD=-186.21, 95%CI(-286.06, -86.36)] and hospitalization cost [WMD=-1.68, 95%CI(-2.27, -1.10)]. There were no significant differences between the two groups in VAS(low back)[WMD=-0.00, 95%CI(-0.26, 0.27)], JOA scores[WMD=0.26, 95%CI(-1.59, 2.11)], ODI[WMD=0.26, 95%CI (-1.59, 2.11)], intervertebral space height of the surgical segment[WMD=0.01, 95%CI(-0.61, 0.63)] changes from pre-operatively to the final follow-up. There were no significant differences in fusion rate[OR=0.31, 95%CI(0.10, 1.03)] and complication rate[OR=1.43, 95%CI (0.60, 3.40)] between the two groups at final follow-up. Conclusions: UPSFS internal fixation can achieve similar clinical efficacy and safety as BPS internal fixation, beside, it can improve the degree of leg pain more significantly, reduce surgical incision, operative time, intraoperative blood loss, postoperative drainage volume, and hospitalization costs.