单双侧椎弓根螺钉内固定并后路腰椎体间融合修复腰椎退行性疾病的系统评价  

System evaluation of unilateral and bilateral pedicle screw fixation and posterior lumbar interbody fusion in the repair of lumbar degenerative diseases

作　　者：钟远鸣[1] 付拴虎 李智斐[1] 伍亮[1] 周劲衍[1] 莫怡[1] 卢大汉 

机构地区：[1]广西中医药大学第一附属医院骨一科,广西壮族自治区南宁市530023

出　　处：《中国组织工程研究》2016年第9期1353-1360,共8页Chinese Journal of Tissue Engineering Research

基　　金：广西科学研究与技术开发计划项目(桂科攻1140003B-56)~~

摘　　要：背景:目前有关植骨融合内固定修复腰椎退行性疾病的治疗方式趋于多元化,但后路腰椎体间融合单双侧椎弓根螺钉置入内固定方式在临床上仍然常见,两种方式均能达到满意疗效,但哪种方式相对更具优势仍存争议。目的:通过Meta分析系统评价单侧与双侧椎弓根螺钉置入内固定单节段腰椎间融合修复腰椎退行性疾病的疗效和安全性。方法:按照Cochrane协作网制订的检索策略进行检索,计算机检索MEDLINE、Pub Med、EMBASE、中国生物医学文献数据库(CBMdisc)、中国期刊全文数据库(CNKI)、中文科技期刊全文数据库(VIP)及WanF ang Data。收集单侧与双侧椎弓根螺钉置入内固定单节段腰椎间融合修复腰椎退行性疾病的临床随机对照试验,由两名评价员严格按照纳入与排除标准筛选文献、提取资料,并对其方法学质量进行评价。对符合纳入标准的研究采用RevM an 5.1软件进行Meta分析。结果与结论:最终纳入6个随机对照试验,共507例研究对象。Meta分析结果显示,单侧与双侧椎弓根螺钉置入内固定在单节段腰椎间融合修复腰椎退行性疾病的对比中,手术时间[WMD=-40.29,95%CI(-43.79,-36.79)]、术中出血量[WMD=-74.13,95%CI(-86.13,-62.13)]、住院时间[WMD=-1.04,95%CI(-1.30,-0.79)]、终末随访目测类比评分[WMD=0.33,95%CI(0.24,0.42)]、终末随访Oswestry功能障碍指数[WMD=-1.07,95%CI(-1.57,-0.56)]之间差异均有显著性意义,单侧优于双侧(P<0.000 1);并发症发生率[RR=0.54,95%CI(0.25,1.17)]和融合率[RR=0.53,95%CI(0.22,1.28)]之间差异均无显著性意义(P=0.12和P=0.16)。提示单侧与双侧椎弓根螺钉置入内固定单节段腰椎间融合修复腰椎退行性疾病均能取得满意效果,单侧内固定可以减少手术时间、术中出血量、住院时间,治疗后短期内目测类比评分、Oswestry功能障碍指数改善明显。BACKGROUND： At present, the internal fixation and fusion surgical treatment of lumbar degenerative disease tends to diversify, but posterior lumbar interbody fusion within a single bilateral pedicle screw fixation is still common in clinical practice; the two ways after treatment can achieve satisfactory clinical efficacy, but which way has advantages is still controversial. OBJECTIVE： To evaluate the efficacy and safety of unilateral and bilateral pedicle screw fixation and single segment lumbar interbody fusion in the repair of lumbar degenerative disease by a meta-analysis system. METHODS： According to the Cochrane Collaboration search strategy, we searched MEDLINE, Pub Med, EMBASE, CBMdisc, CNKI, VIP and WanF ang Data. Randomized controlled trials concerned unilateral and bilateral pedicle screw fixation and single segment lumbar interbody fusion in the treatment of lumbar degenerative diseases. By two reviewers, in strict accordance with inclusion and exclusion criteria, literatures were screened, data were extracted, and the methodology quality of included trials was critically assessed. RevM an5.1 software was used for meta-analysis. RESULTS AND CONCLUSION： Six randomized controlled trials involving 507 patients were included. The results of meta-analysis showed that fixed unilateral and bilateral pedicle screw between single lumbar fusion and surgery in the treatment of lumbar degenerative diseases, significant differences were detected in surgical time [WMD=-40.29, 95% CI（-43.79,-36.79）], intraoperative blood loss [WMD=-74.13, 95% CI（-86.13,-62.13）], length of hospital stay [WMD=-1.04, 95% CI（-1.30,-0.79）], final follow-up Visual Analogue Scale score [WMD=0.33, 95% CI（0.24, 0.42）], final follow-up Oswestry dysfunction index [WMD=-1.07, 95% CI（-1.57,-0.56）]; unilateral side was better than bilateral side（P〈0.000 1）. There was no significant difference in complication rate [RR=0.54, 95% CI（0.25, 1.17）] and fusion rate [RR=0.53, 95% CI（0.22, 1.28）]（P=0.12 and P=0.

关 键 词：椎间盘移位 椎管狭窄 脊柱融合术 内固定器 Meta分析 组织工程 骨科植入物 脊柱植入物 腰椎退行性疾病 单侧 双侧 椎弓根螺钉 内固定 后路椎体间植骨融合 

分 类 号：R318[医药卫生—生物医学工程]