斜外侧入路与微创经椎间孔入路椎间融合术治疗腰椎退行性疾病临床疗效的Meta分析

A Meta-analysis of the clinical efficacy of oblique lumbar interbody fusion versus minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative disease

中文关键词:  腰椎退行性疾病  斜外侧入路椎间融合术  微创经椎间孔入路椎间融合术  Meta分析

英文关键词:Lumbar degenerative disease  Oblique lumbar interbody fusion  Minimally invasive transforaminal lumbar interbody fusion  Meta-analysis

中文摘要:

  【摘要】 目的：系统评价斜外侧入路椎间融合术（oblique lumbar interbody fusion，OLIF）与微创经椎间孔入路椎间融合术（minimally invasive transforaminal lumbar interbody fusion，MIS-TLIF）治疗腰椎退行性疾病（lumbar degenerative disease，LDD）的临床疗效。方法：系统检索中国知网（CNKI）、维普（VIP）、万方数据（WANFANG DATA）、中国生物医学文献服务系统（SinoMed）、PubMed、Cochrane Library、Embase、Web of Science等中英文数据库中关于OLIF与MIS-TLIF治疗LDD的临床对比研究文献，检索时限为自数据库建库至2021年12月，采用纽卡斯尔-渥太华量表（Newcastle-Ottawa scale，NOS）对纳入的研究进行质量评价。提取手术时间、出血量、下地时间、住院时间、疼痛视觉模拟（visual analog scale，VAS）评分、Oswestry功能障碍指数（Oswestry disability index，ODI）、椎间隙高度（disc height，DH）、腰椎前凸角（lumbar lordosis angle，LLA）、并发症发生率、融合率等指标，应用RevMan 5.3软件进行Meta分析。结果：共纳入16篇文献，均为队列研究，NOS评价均为中高质量。共有1220例患者，其中OLIF组572例，MIS-TLIF组648例。Meta分析结果显示，OLIF组手术时间（MD=-26.00，95％CI：-38.69～-13.32，P＜0.0001）和住院时间（MD=-2.81，95％CI：-3.71～-1.92，P＜0.00001）更短，下地时间更早（MD=-0.54，95％CI：-0.70～-0.37，P＜0.00001），术中出血量（MD=-44.04，95％CI：-46.97～-41.12，P＜0.00001）更少，VAS评分（MD=-0.37，95％CI：-0.67～-0.06，P=0.02）、ODI（MD=-4.48，95％CI：-8.75～-0.20，P=0.04）、DH（MD=1.08，95％CI：0.73～1.43，P＜0.00001）、LLA（MD=3.00，95％CI：1.61～4.38，P＜0.0001）的改善均优于MIS-TLIF组。两组并发症发生率（OR=1.38，95％CI：0.96～2.00， P=0.09）、融合率（OR=2.13，95％CI：0.91～4.97，P=0.08）无显著性差异。结论：相较于MIS-TLIF，OLIF治疗LDD手术时间、住院时间、下地时间较短，术中出血量较少，缓解疼痛和功能障碍、改善椎间隙高度和腰椎前凸角更优；而并发症发生率和融合率则无明显差异。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical efficacy of oblique lumbar interbody fusion(OLIF) versus minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) in the treatment of lumbar degenerative disease(LDD) systematically. Methods: Literature of clinical comparative studies of OLIF and MIS-TLIF for LDD were searched from the databases of CNKI, VIP, WANFANG DATA, SinoMed, PubMed, Cochrane Library, Embase, and Web of Science from inception to December 2021. The Newcastle-Ottawa scale(NOS) was used to assess the quality of the included studies. The data of outcome indicators including operation duration, intraoperative blood loss, ambulation time, hospital stay, visual analog scale(VAS) score, Oswestry disability index(ODI), disc height(DH), lumbar lordosis angle(LLA), complication incidence, and fusion rate were extracted, and a Meta-analysis was completed with Review Manager 5.3. Results: A total of 16 cohort studies of medium or high quality according to NOS criteria were included in our Meta-analysis, which involved 1220 patients(572 in the OLIF group and 648 in the MIS-TLIF group). And the result of Meta-analysis showed that the OLIF group had a shorter operation duration(MD=-26.00, 95％CI: -38.69--13.32, P＜0.0001) and hospital stay(MD=-2.81, 95％CI: -3.71--1.92, P＜0.00001), an earlier ambulation time(MD=-0.54, 95％CI: -0.70--0.37, P＜0.00001), and a less intraoperative blood loss(MD=-44.04, 95％CI: -46.97--41.12, P＜0.00001) than did in the MIS-TLIF group. The OLIF group had a significantly better VAS improvement(MD= -0.37, 95％CI: -0.67--0.06, P=0.02) and ODI improvement(MD=-4.48, 95％CI: -8.75--0.20, P=0.04) than the MIS-TLIF group. The restorations of DH(MD=1.08, 95％CI: 0.73-1.43, P＜0.00001) and LLA(MD=3.00, 95％CI: 1.61-4.38, P＜0.0001) were better in the OLIF group than those in the MIS-TLIF group. There was no significanct difference between the two groups in the incidence of complications(OR=1.38, 95％CI: 0.96-2.00, P=0.09) and the fusion rate(OR=2.13, 95％CI: 0.91-4.97, P=0.08). Conclusions: OLIF is superior to MIS-TLIF in shortening operation duration, hospital stay, and ambulation time, reducing intraoperative blood loss, relieving pain and dysfunction, and improving DH and LLA. In the meantime, it′s not significantly different from MIS-TLIF in terms of the incidence of complications and fusion rate.