经皮内镜下经椎间孔腰椎间融合术与传统微创经椎间孔腰椎间融合术治疗腰椎退行性疾病临床疗效与安全性的Meta分析

Meta-analysis of clinical efficacy and safety of percutaneous endoscopic and minimally invasive transforaminal lumbar interbody fusions in the treatment of lumbar degenerative diseases

中文关键词:  腰椎退行性疾病  微创经椎间孔腰椎间融合术  经皮内镜下经椎间孔腰椎间融合术  Meta分析

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

中文摘要:

  【摘要】 目的：通过Meta分析评价经皮内镜下经椎间孔腰椎间融合术（percutaneous endoscopic transforaminal lumbar interbody fusion，PE-TLIF）与传统微创经椎间孔腰椎间融合术（minimally invasive transforaminal lumbar interbody fusion，MIS-TLIF）治疗腰椎退行性疾病（lumbar degenerative diseases，LDD）的临床疗效与安全性。方法：检索PubMed、Cochrane Library、Web of science、Embase、Medline、CNKI、万方、维普数据库进行了全面搜索关于PE-TLIF和MIS-TLIF治疗LDD的临床预后和并发症的相关研究。提取纳入研究的结局指标数据，包括视觉模拟评分（visual analogue scale，VAS）、Oswestry功能障碍指数（Oswestry disability index，ODI）、日本骨科协会（Japanese Orthopaedic Association，JOA）评估治疗分数；手术时间、透视时间、术中出血量、术后引流量、下床时间、住院时间、融合率和手术相关并发症。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，2篇RCT，1篇前瞻性队列研究，7篇回顾性研究，总样本量696例，其中PE-TLIF组患者345例，MIS-TLIF组患者351例。Meta分析结果显示，PE-TLIF组住院时间[MD＝-1.45，95%CI（-2.17，-0.74），P＜0.0001]、术中失血量[MD＝-56.39，95%CI（-77.50，-35.29），P＜0.00001]、术后引流量[MD＝-46.27，95%CI（-67.68，-24.85），P＜0.0001]、下地时间[MD＝-2.84，95%CI（-4.97，-0.71），P=0.009]方面均优于MIS-TLIF组；MIS-TLIF组手术时间[MD＝35.89，95%CI（16.82，54.95），P=0.0002]、术中透视时间[MD＝15.42，95%CI（15.28，15.55），P＜0.00001]及下肢VAS评分[MD＝0.10，95%CI（0.01，0.19），P=0.02]优于PE-TLIF组；二者在术后背部VAS评分[MD＝-0.02，95%CI（-0.10，0.06），P=0.68]、ODI[MD＝-0.14，95%CI（-0.71，0.43），P=0.62]、术后JOA评分[MD＝ -0.11，95%CI（-0.48，0.26），P=0.55]、并发症发生率[OR＝1.69，95%CI（0.81，3.54），P=0.16]及融合率[OR＝0.56，95%CI（0.23，1.37），P=0.20]方面无显著性差异。结论：PE-TLIF和MIS-TLIF作为腰椎退行性疾病的微创手术，都具有明显的临床疗效和安全性，两种术式的中远期临床疗效、手术并发症以及融合率方面无明显差异，PE-TLIF在住院时间、术中失血量、术后引流量、下地时间等方面更占优势，PE-TLIF具有手术创伤小、恢复快、术后早期缓解腰腿部疼痛等优点。

英文摘要:

  【Abstract】 Objectives: To evaluate the efficacies of percutaneous endoscopic transforaminal lumbar interbody fusion(PE-TLIF) and traditional minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) in the treatment of lumbar degenerative diseases(LDD) by meta-analysis. Methods: The databases of PubMed, Cochrane Library, Web of science, Embase, Medline, CNKI, Wanfang and VIP were searched for the relative studies of the clinical prognosis and complications of PE-TLIF and MIS-TLIF in LDD treatment. The outcome data were extracted, including visual analog scale(VAS), Oswestry disability index(ODI), Japanese Orthopaedic Association(JOA) score, operative time, fluoroscopy time, intraoperative blood loss, postoperative drainage volume, leaving bed time, length of hospital stay, fusion rate, and operation-related complications. Meta-analysis was carried out by Review Manager 5.3 software. Results: A total of 10 articles(2 RCT studies, 1 prospective cohort study and 7 retrospective studies) were included, involving a total sample size of 696 cases, including 345 cases in PE-TLIF group and 351 cases in MIS-TLIF group. Meta-analysis showed that the length of hospital stay[MD=-1.45, 95%CI(-2.17, -0.74), P＜0.0001], intraoperative blood loss[MD=-56.39, 95%CI(-77.50, -35.29), P＜0.00001], postoperative drainage volume[MD=-46.27, 95%CI(-67.68, -24.85), P＜0.0001], leaving bed time[MD=-2.84, 95%CI(-4.97, -0.71), P=0.009] of the PE-TLIF group were better than those of MIS-TLIF group; And the MIS-TLIF group was better in operative time[MD=35.89, 95%CI(16.82, 54.95), P=0.0002], intraoperative fluoroscopy time[MD=15.42, 95%CI(15.28, 15.55), P＜0.00001] and leg pain VAS score[MD=0.10, 95%CI(0.01, 0.19), P=0.02] than those of the PE-TLIF group; There were no significant differences in postoperative back pain VAS score[MD=-0.02, 95%CI(-0.10, 0.06), P=0.68], ODI[MD=-0.14, 95%CI(-0.71, 0.43), P=0.62], JOA score[MD=-0.11, 95%CI(-0.48, 0.26), P=0.55], complication rate[OR=1.69, 95%CI(0.81, 3.54), P=0.16] or fusion rate [OR=0.56, 95%CI(0.23, 1.37), P=0.20] between the two groups. Conclusions: As minimally invasive operations for LDD, both PE-TLIF and MIS-TLIF have obvious clinical efficacies and safety with certain advantages and disadvantages each; The results of this meta-analysis show that although no significant difference between the two procedures in terms of the mid- and long-term clinical efficacy, surgical complications and fusion rate, PE-TLIF is superior in length of hospital stay, intraoperative blood loss, postoperative drainage volume, and leaving bed time, and that PE-TLIF has the advantages of less surgical trauma, faster recovery and less early postoperative low back and leg pain.