后路髓核摘出术后融合与不融合治疗腰椎间盘突出症临床疗效的系统评价  

Posterior Approach Discectomy with or without Fusion for Lumbar Disc Herniation:A systematic Review

作　　者：岳勇[1] 艾尔肯萨德尔[1] 

机构地区：[1]新疆医科大学第一附属医院骨科分院创伤1科,乌鲁木齐830054

出　　处：《中国循证医学杂志》2007年第7期523-530,共8页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价后路髓核摘出术后融合与不融合治疗腰椎间盘突出的疗效。方法计算机检索MEDLINE(1950～2007.1)、OVID(1950～2007.4)、中国生物医学文献光盘数据库CBMdisk(1978～2007.1)、万方数据库(1981～2007.3),手工检索《中华骨科杂志》《、骨与关节损伤》《、脊柱脊髓杂志》、《颈腰痛》等4种中文骨科核心杂志(截止自2007年3月),由两名评价员独立选择试验、提取资料并交叉核对,而后按Cochrane系统评价的方法评价纳入文献的方法学质量并提取有效数据进行Meta分析。结果共纳入4个半随机对照试验,5个临床对照试验,包括1911例患者,文献质量评价结果显示,9个研究均可能存在选择性偏倚、实施偏倚和测量偏倚的高度可能性。其中8个未提供腰椎间盘突出病人术后早期疼痛评分率的原始数据;而对其他指标进行的Meta分析结果显示:融合与不融合治疗腰椎间盘突出的疗效在总体疗效,各研究间有很大异质性(I2=91.9%),未对其进行合并分析。术后出现腿痛[RR0.94,95%CI(0.69,1.28)]、需要二次手术的患者例数[RR0.77,95%CI(0.57,1.04)]。、术后腰椎管狭窄[RR1.23,95%CI(0.26,5.86)]、以及术后腰椎间盘突出复发(其他间隙)[RR1.05,95%CI(0.49,2.26)]方面,其差异均无统计学意义(P>0.05);围手术期并发症两组差异有统计学意义[RR1.46,95%CI(1.06,2.00)]。内固定亚组融合与不融合治疗腰椎间盘突出的总体疗效比较,两组治疗疗效差别有统计学意义[RR1.13,95%CI(1.05,1.21)],术后出现腰痛患者人数[RR0.70,95%C(I0.53,0.94)]、术后腰椎间盘突出复发(不分间隙)[RR0.30,95%CI(0.18,0.48)]以及术后腰椎间盘突出复发(同一间隙)[RR0.12,95%CI(0.04,0.37)]方面,其差异均有统计学意义(P<0.05)。结论后路髓核摘出术后融合与不融合治疗腰椎间盘突出在总体疗效、术后出现腿痛、需要二次手术的患者例数、术后腰椎管狭窄、术后腰椎间盘突出复发(其他�Objective To evaluate the efficacy of posterior approach discectomy with and without fusion in the treatment of lumbar discherniation. Methods We searched MEDLINE （1950 to June 2007）, OVID （1950 to April 2007）, PUBMED, the China Biological Medicine Database （1978 to June 2007） and Wanfang Database （1981 to February 2007）. We also handsearched several relevant journals for randomized controlled trials （RCTs） and quasi-randomized controlled trials （quasi-RCTs） comparing posterior approach discectomy with and without fusion in the treatment of lumbar discherniation. The quality of the included trials was assessed. The Cochrane Collaboration＇s RevMan 4.2.8 software was used for statistical analysis. Results Nine eligible trials involving 1911 patients were included. The meta-analyses found no statistically significant differences between the two operative procedures in the incidence of postoperative leg pain [RR 0.94, 95%CI（0.69, 1.28）], the proportion of patients requiring re-operation [RR 0.77, 95% CI （0.57, 1.04）], the incidence of post-operative lumbar canal stenosis [RR 1.23, 95%CI （0.26, 5.86）], and the relapse rate at other intervertebral spaces [RR 1.05, 95%CI （0.49, 2.26）] （P〉0.05）.There is statistically significant differences between the two group in the incidence of peri-operative complications [RR 1.46, 95%CI （1.06, 2.00）]. Discectomy plus fusion was superior to discectomy alone in incidence of postoperative back pain [RR 0.70, 95%CI （0.53, 0.94）], relapse rate at either intervertebral space [RR 0.30, 95%CI （0.18, 0.48）] and at the same intervertebral space [RR 0.12, 95%CI （0.04, 0.37）]. Conclusions Since all the included studies were controlled trials with a great potential for biases, high-quality, large-scale randomized controlled trials are required.

关 键 词：腰椎间盘突出 髓核摘出术 融合 系统评价 临床对照试验 

分 类 号：R687.3[医药卫生—骨科学]