成人腰椎侧弯长节段固定选择不同远端融合椎的荟萃分析  

Long-segment spinal fusion at different distal instrumented vertebrae for treatment of adult lumbar scoliosis: a meta-analysis

作　　者：刘立洋[1,2] 陈佳海[2] 文天用[2] 王德利[2] 阮狄克[2] 

机构地区：[1]第二军医大学海军临床医学院骨科,北京市100048 [2]海军总医院骨科,北京市100048

出　　处：《中国矫形外科杂志》2017年第5期432-437,共6页Orthopedic Journal of China

摘　　要：[目的]荟萃分析长节段融合内固定术治疗成人腰椎侧弯选择不同远端融合椎的术后并发症及矫形效果。[方法]计算机在Pubmed、Ovid、Embase、Web of science、Cochrane Library数据库、中国生物医学文献服务系统(SinoMed)、中国生物医学期刊引文数据库(CMCI)、中国期刊全文数据库(CNKI)中全面检索1996年1月~2015年12月公开发表的文献。由2名评价员独立的根据纳入和排除标准严格筛选提取资料和质量评价后,采用Review Manager 5.2软件进行数据分析。[结果]纳入研究的文献共5篇,共计421例。其中179例选择L_5为远端融合椎,242例选择S1为远端融合椎。荟萃分析显示,术后假关节形成率(P=0.01)远端融合椎选择L_5组优于S_1组,而术后翻修率(P=0.10)、术后ASD发生率(P=0.06)、术后Cobb角改善程度(P=0.74)、术后CVA改善程度(P=0.93)、术后LL改善程度(P=0.44)以及术后SVA改善程度(P=0.57)的比较两组间差异均无统计学意义。[结论]现有的证据表明,对于成人腰椎侧弯患者,远端融合椎选择L_5或是S_1在术后ASD发生率、术后翻修率及矫形效果上未见明显统计学差异,但L_5组假关节发生率低于S_1组。受本文纳入研究文献的数量和质量限制,上述结论尚需更多高质量的随机对照研究论证。[Objective] To investigate the postoperative complications and clinical outcome of long-segment spinal fusion at different distal instrumented vertebrae in the treatment of adult lumbar scoliosis. [Methods] A literature search was performed in Pub Med, Ovid, EMBASE, Web of science, the Cochrane Library, CBM, CMCI, and CNKI to collect the articles published from January 1996 to December 2015. After data extraction and quality evaluation, which were performed by two reviewers independently according to the inclusion and exclusion criteria, the data were analyzed by Review Manager 5.2. [Results] A total of 5 articles involving 421 patients were included in the analysis. Of the 421 cases, L5 was selected as the distal instrumented vertebra in 179 cases（L5 group） and S1 in the other 242 cases（S1 group）. Meta-analysis showed that the L5 group had a significantly higher postoperative pseudarthrosis formation rate than the S1 group（P=0.01）. However, there were no significant differences in postoperative renovation rate（P=0.10）, postoperative incidence of adjacent segment disease（ASD）（P=0.06）,postoperative improvement degree of Cobb angle（P=0.74）, postoperative improvement degree of coronal vertical axis（P=0.93）,postoperative improvement degree of lumbar lordosis（P=0.44）, and postoperative improvement degree of sagittal vertical axis（P=0.57） between the two groups. [Conclusions] For adult lumbar scoliosis, L5 is better than S1 as the distal instrumented vertebra. Due to the quality and quantity of included articles, the conclusion still needs to be confirmed by more high-quality randomized controlled studies.

关 键 词：成人腰椎侧弯 远端融合椎 治疗结果 荟萃分析 

分 类 号：R687.3[医药卫生—骨科学]