腰椎融合和腰椎间盘置换治疗腰椎间盘退变性病变疗效比较的Meta分析  

Comparison of total disc replacement versus fusion for lumbar degenerative disc disease： a Meta-analysis of randomized controlled trials

作　　者：姚立炜[1] 王天仪[1] 刘洋[1] 冯世庆[1] 张彬[1] 曹代桂[1] 张衍军[1] 

机构地区：[1]天津医科大学总医院骨科,300052

出　　处：《中华外科杂志》2014年第5期370-375,共6页Chinese Journal of Surgery

摘　　要：目的 系统评价腰椎融合术和腰椎间盘置换术治疗腰椎间盘退变性病患的相关临床结果,为手术方式的选择提供参考依据.方法 计算机系统检索PubMed、EMBase、COCHRANE图书馆、中国生物医学文献数据库、CNKI中国知网数据库、维普中文科技期刊数据库等.检索时间从建库到2013年10月.搜集关于比较腰椎融合和腰椎间盘置换治疗腰椎间盘退变性疾病的临床随机对照试验.通过方法学评估后,提取有价值的评价指标数据资料.应用RevMan 5.1软件对数据进行统计分析.结果 纳入6篇随机对照试验,共1 658例,其中腰椎融合组543例,腰椎间盘置换组1115例.Meta分析结果显示：腰椎间盘置换组在视觉模拟量表（VAS）评分（OR=-3.33,95％ CI：-5.94～-0.71,P=0.01）、Oswestry功能障碍指数（ODI）（OR=-5.21,95％CI：-7.51～-2.92,P=0.00）和并发症发生率（OR=0.45,95％ CI：0.21 ～0.95,P=0.04）方面优于腰椎融合组.在手术时间、出血量和二次手术率方面两组差异无统计学意义（P＞0.05）.但是在2年和5年亚组分析中发现,两组并发症率差异无统计学意义（P＞0.05）.结论 腰椎间盘置换在近期临床有效性方面可能要优于腰椎融合,但是远期的疗效需要进一步验证.Objective To compare the related clinical outcomes of total disc replacement （TDR） versus fusion in management of lumbar degenerative disc disease （LDDD） and provid available basis for choice of surgical procedure. Methods Computer systematically researched PubMed,EMBase,COCHRANE Library, CBMWin, CNKI, VIP databases for randomized controlled trials comparing TDR and fusion for LDDD. Data were searched until October 2013. The available statistical data was extracted after methodological assessment. The statistical soft RevMan 5.1 was used to analyze the results. Results Total 1 658 cases of patients in 6 studies were conducted, including 543 cases of fusion and 1 115 cases of TDR. The results of Meta-analysis showed that TDR was superior to fusion in term of visual analogue scale （VAS） （ OR = - 3.33,95% CI： - 5.94 - - 0. 71 ,P = 0. 01 ）, Owestry disability index （ODI） （ OR = - 5.21,95% CI： - 7.51 - - 2. 92, P = 0. 00 ）, complication （ OR = 0. 45,95 % CI： 0. 21 - 0. 95, P = 0. 04 ）. There were no statistically difference regarding operating time, blood loss and reoperation （P 〉 0. 05 ）. However, there was no difference in term of complication in two-year and five-year sub-analysis. Conclusion Regardless TDR may be more effective comparable to lumbar fusion at the immediate postoperative time, vigorous evidence is still requisite to certify the result in long-term follow-up.

关 键 词：腰椎 椎间盘切除术 融合 随机对照试验 META分析 

分 类 号：R687.3[医药卫生—骨科学]