单侧双通道内镜下腰椎融合术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比较的Meta分析

Meta-analysis of the clinical efficacies of unilateral biportal endoscopic lumbar interbody fusion and minimally invasive transforaminal lumbar interbody fusion in the treatment of lumbar degenerative diseases

中文关键词:  腰椎退行性疾病  单侧双通道内镜下腰椎融合术  微创经椎间孔入路腰椎融合术  Meta分析

英文关键词:Degenerative diseases of the lumbar spine  Unilateral biportal endoscopic lumbar interbody fusio  Minimally invasive transforaminal lumbar interbody fusion  Meta-analysis

中文摘要:

  【摘要】 目的：系统评价单侧双通道内镜下腰椎融合术（unilateral biportal endoscopic lumbar interbody fusion，ULIF）与微创经椎间孔入路腰椎融合术（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）、中国生物医学文献服务系统（SinoMed）、PubMed、Cochrane Library、Embase、Web of Science 等8个中英文数据库中关于ULIF与MIS-TLIF治疗LDD的临床对照研究文献，检索时限为自数据库建库至2023年9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、手术出血量、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）、并发症发生率、椎间盘高度、融合率等指标，应用 RevMan 5.4.1软件进行Meta分析。结果：共纳入11篇文献，均为队列研究，NOS评价均为中高质量。共有800例患者，其中ULIF组380例，MIS-TLIF组420例。Meta分析结果显示，ULIF手术组腰部VAS（术后1～3个月）[MD=-0.43，95%CI（-0.70，-0.15）]、腰部VAS（末次随访＞一年）[MD=-0.09，95%CI（-0.18，-0.00）]、ODI（术后1～3个月）[MD=-1.37，95%CI（-2.46，-0.28）]、住院时间[WMD=-0.75，95%CI（-1.33，-0.17）]、术中出血[MD=-78.72，95%CI（-113.20，-44.23）]等方面优于MIS-TILF手术组，MIS-TLIF手术组在手术时间[MD=30.28，95%CI（13.86，46.71）]上优于UILF手术组；二者在腿部VAS评分（术后1～3个月）[MD=-0.12，95%CI（-0.30，0.06）]、腿部VAS评分（末次随访＞1年）[MD=-0.04，95%CI（-0.15，0.07）]、ODI（末次随访＞1年）[MD=-0.46，95%CI（-1.02，0.11）]、腰椎前突角[MD=0.39，95%CI（-1.12，1.90）]、椎间盘高度[MD=0.03，95%CI（-0.24，0.30）]、融合率[MD=0.97，95%CI（0.92，1.03）]及并发症发生率[MD=0.82，95%CI（0.45，1.48）]等方面无明显差异。结论：相较于MIS-TLIF，ULIF在改善腰痛症状和早期恢复功能、减少术中出血、缩短住院时间等方面有优势，具有手术创伤小、恢复快的优势。二者在远期疗效、并发症以及融合率方面无明显差异。

英文摘要:

  【Abstract】 Objectives: To systematically evaluate the clinical efficacies of unilateral biportal endoscopic lumbar interbody fusion(ULIF) and minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) in the treatment of lumbar degenerative diseases(LDD). Methods: Clinical controlled studies on ULIF and MIS-TLIF in the treatment of LDD were systematically retrieved from Chinese and English databases, including CNKI, VIP, WanFang, SinoMed, PubMed, Cochrane Library, Embase, and Web of Science. The retrieval time limit was from the establishment of the database to September 2023. The quality of the included studies was evaluated by the Newcastle-Ottawa scale(NOS). The indexes of operation time, surgical bleeding, hospitalization time, visual analog scale(VAS), Oswestry disability index(ODI), incidence of complications, disc height, and fusion rate were extracted, and Meta-analysis was performed by RevMan 5.4.1 software. Results: A total of 11 studies were included, all of which were cohort studies, and all of which were evaluated as medium-high quality by NOS. There were 800 patients, including 380 in the ULIF group and 420 in the MIS-TLIF group. The results of Meta analysis showed that the hospitalization time[WMD=-0.75, 95%CI(-1.33, -0.17)], low back pain VAS(1-3 months after operation)[MD=-0.43, 95%CI(-0.70, -0.15)], low back pain VAS(final follow-up>1 year)[MD=-0.09, 95%CI(-0.18, -0.00)], ODI(1-3 months after operation)[MD=-1.37, 95%CI(-2.46, -0.28)], and intraoperative bleeding[MD=-78.72, 95%CI(-113.20, -44.23)] in the ULIF group were better than those in the MIS-TLIF group. The operation time[MD=30.28, 95%CI(13.86, 46.71)] in the MIS-TLIF group was better than that in the ULIF group. There were no significant differences in leg pain VAS(1-3 months after operation)[MD=-0.12, 95%CI(-0.30, 0.06)], leg pain VAS(final follow-up>1 year)[MD=-0.04, 95%CI(-0.15, 0.07)], ODI (final follow-up>1 year)[MD=-0.46, 95%CI(-1.02, 0.11)], lumbar lordosis angle[MD=0.39, 95%CI(-1.12, 1.90)], disc height[MD=0.03, 95%CI(-0.24, 0.30)], fusion rate[MD=0.97, 95%CI(0.92, 1.03)] and complication rate[MD=0.82, 95%CI(0.45, 1.48)]. Conclusions: Compared with MIS-TLIF, ULIF has advantages in improving low back pain symptoms and early recovery of function, reducing intraoperative blood loss, shortening hospital stay, which is less in surgical trauma and faster in recovery. There is no significant difference in long-term efficacy, complications, and fusion rate between the two methods.