单纯减压与减压融合手术治疗退变性腰椎滑脱荟萃分析  

Decompression only versus decompression combined with fusion for lumbar degenerative spondylolisthesis:a meta-analysis

作　　者：陈丹祎[1] 刘俊雄[1] 王旭[1] 梁青福 徐帅[2] CHEN Dan-yi;LIU Jun-xiong;WANG Xu;LIANG Qing-fu;XU Shuai(Department of Orthopedics,Shangluo Central Hospital,Shangluo 726000,China;Department of Spinal Surgery,People's Hospital,Peking University,Beijing 100044,China)

机构地区：[1]陕西省商洛市中心医院骨四科,726000 [2]北京大学人民医院脊柱外科,100044

出　　处：《中国矫形外科杂志》2019年第1期51-57,共7页Orthopedic Journal of China

摘　　要：[目的]对单纯减压与减压融合手术治疗退变性腰椎滑脱的疗效进行荟萃分析。[方法]检索数据库包括:Pubmed/Medline、EMBASE、Cochrane Library及Web of Science,两名成员独立筛选文献并提取数据信息,通过Cochrane指南评价文章质量。数据信息包括人口统计学信息,对腰背痛及腿痛的VAS评分、ODI、EQ-5D和患者满意度以及并发症、再手术率、邻近节段退变(ASD)和术后滑脱进展等指标进行荟萃分析。[结果] 6篇RCTs符合纳入标准,4篇RCTs质量较高。224例列入减压组,331例列入融合组,两组平均年龄、性别比及术前VAS评分差异均无统计学意义。在腰背痛(OR=0.77,95%CI:0.36～1.65,P=0.50)和下肢痛VAS改善方面(MD=0.08, 95%CI:-1.20～1.35,P=0.91),减压组和融合组差异无统计学意义。两组间ODI (MD=1.49,95%CI:7.23～10.21,P=0.74) EQ-5D (MD=0.03,95%CI:-0.05～0.12,P=0.43)和患者满意度(MD=0.03,95%CI:0.05～0.12,P=0.43)差异无统计学意义。两组间并发症、再手术率和术后滑脱进展的差异无统计学意义(P>0.05)。[结论]减压联合融合术治疗DS患者的整体疗效并不优于单纯减压术。[Objective] To compare the clinical outcomes of decompression only versus decompression combined with fusion for lumbar degenerative spondylolisthesis(DS) by a meta-analysis. [Methods] The databases included Pubmed/Medline,EMBASE, Cochrane Library and Web of Science were retrieved with a certain search strategy and inclusion criteria. The eligible trials and extracted information were independently assessed the two reviewers, and the evaluation of article quality was guided with Cochrane Handbook for Systematic Reviews of Interventions. The demographic information, VAS change of back and leg pain, ODI, EQ-5 D, clinical satisfaction, incidence of complication, adjacent segment degeneration(ASD), reoperation rate, and postoperative DS progress were evaluated. [Results] A total of 6 RCTs, including 4 high quality RCTs with low risk of bias, met the inclusion criteria were enrolled into this study, involving a total of 555 patients. Of the patients, 224 were in the decompression group, while the remaining 331 were in the fusion group. There were on significant differences in the age, sex ratio and preoperative VAS between them. In term of VAS improvement postoperatively, no significant differences were noticed regarding to the back pain(OR=0.77, 95% CI: 0.36~1.65, P=0.50) and leg pain(MD=0.08, 95% CI:-1.20~1.35, P=0.91) between the two groups. In addition, no significant differences were proved in the ODI(MD=1.49, 95% CI: 7.23~10.21, P=0.74),EQ-5 D(MD=0.03, 95% CI:-0.05~0.12, P=0.43) and patients. satisfaction(MD=0.03, 95% CI : 0.05~0.12, P=0.43) between them. Furthermore, no significant differences were found in incidence of complications, reoperation rate and postoperative DS progress between the two groups(P>0.05). [Conclusion]The decompression combined with spinal fusion does not take any advantage over the decompression only for lumbar degenerative spondylolisthesis.

关 键 词：退变性腰椎滑脱 单纯减压 减压融合术 荟萃分析 

分 类 号：R681.57[医药卫生—骨科学]