髓核摘除与椎间融合修复伴有Modic改变腰椎间盘突出症的Meta分析  

Discectomy versus interbody fusion for lumbar disc herniation with Modic change: a meta-analysis

作　　者：王文达[1] 金祺[1] 阮文枫 平安松[1] 

机构地区：[1]武汉大学中南医院骨科,湖北省武汉市430071

出　　处：《中国组织工程研究》2016年第9期1345-1352,共8页Chinese Journal of Tissue Engineering Research

摘　　要：背景:目前已有大量研究证实髓核摘除和椎间融合在修复腰椎间盘突出症方面均有确切疗效。但是对于有Modic改变的腰椎间盘突出症,两种修复方式的优劣尚无定论。目的:系统评价髓核摘除与椎间融合对伴有Modic改变腰椎间盘突出症修复效果的差异。方法:计算机检索PubM ed、Embase、The Cochrane Library(2015年第2期)、CBM、CNKI、VIP、WanF ang Data等数据库,查找比较髓核摘除与椎间融合修复伴有Modic改变的腰椎间盘突出症的随机对照试验,检索时限从建库至2015年5月1日,以腰痛目测类比评分、腿痛目测类比评分、Oswestry功能障碍指数、腰椎日本骨科学会评分、并发症例数、MacN ab标准评价结果为临床结局指标。采用RevM an5.2软件进行Meta分析。结果与结论:最终纳入9个随机对照试验研究,共945例患者。Meta分析结果显示,相比髓核摘除组,椎间融合组修复术后腰痛目测类比评分更低[MD=0.81,95%CI(0.69,0.92),P<0.000 01]、Oswestry功能障碍指数更低[MD=2.07,95%CI(1.62,2.52),P<0.000 01]、日本骨科学会评分更高[MD=-2.32,95%CI(-4.32,-0.32),P=0.02]。两组患者修复术后腿痛目测类比评分、Mac Nab标准评价结果差异无显著性意义。提示椎间融合修复伴有Modic改变的腰椎间盘突出症安全有效,且较髓核摘除更具优势。BACKGROUND： At present, a large number of studies have proved that the discectomy and interbody fusion are effective in treatment of lumbar disc herniation. But for the treatment of lumbar disc herniation with Modic change, the advantages and disadvantages of above two kinds of surgical methods are still inconclusive. OBJECTIVE： To systematically review the effectiveness of discectomy versus interbody fusion in treatment of lumbar disc herniation with Modic change. METHODS： We searched PubM ed, Embase, The Cochrane Library（Issue 2, 2015）, CBM, CNKI, VIP and Wan Fang database for randomized controlled trials on discectomy versus interbody fusion for lumbar disc herniation with Modic change from inception to May 1st, 2015. Clinical outcomes were back pain Visual Analog Scale, leg pain Visual Analog Scale, Oswestry Disability Index, lumbar Japanese Orthopaedic Association score, the number of cases affecting complications, and Mac Nab criteria. Meta-analysis was performed using Rev Man 5.2 software. RESULTS AND CONCLUSION： Nine randomized controlled trials were included, involving 945 patients. The results of meta-analysis showed that compared with discectomy group, back pain Visual Analog Scale was lower [MD=0.81, 95%CI（0.69, 0.92）, P 〈0.000 01]; Oswestry Disability Index was lower [MD=2.07, 95%CI（1.62, 2.52）, P〈0.000 01]; lumbar Japanese Orthopaedic Association score was higher [MD=-2.32, 95%CI（-4.32,-0.32）, P=0.02] in the interbody fusion group. No significant difference in leg pain Visual Analog Scale and Mac Nab criteria outcomes was detected between both groups. These findings verified that interbody fusion was safer and more effective for lumbar disc herniation with Modic change, compared with discectomy.

关 键 词：椎间盘移位 脊柱融合术 META分析 随机对照试验 组织工程 骨科植入物 脊柱植入物 髓核摘除 椎间融合 MODIC改变 腰椎间盘突出症 

分 类 号：R318[医药卫生—生物医学工程]