侧入路椎体间融合治疗成人退行性脊柱侧凸:如何以证据来评价?  

Lateral lumbar interbody fusion for adult degenerative scoliosis:how to provide evidence supports

作　　者：金元哲 公伟权[1] 张绍昆[1] 

机构地区：[1]吉林大学第一医院,吉林省长春市130021

出　　处：《中国组织工程研究》2017年第27期4409-4415,共7页Chinese Journal of Tissue Engineering Research

基　　金：国家科技部课题(2009ZX09502-011)~~

摘　　要：背景:大部分循证医学研究中都将成人退行性脊柱侧凸与特发性脊柱侧凸同时纳入,使得研究得到的证据存在一定的间接性,对结论的推广能力造成一定影响。目的:对现有的临床研究进行系统的搜索与分析,对侧入路椎体间融合治疗成人退行性脊柱侧凸的疗效做一综述。方法:第一作者计算机检索Medline,EMBASE,CENTRAL,万方和中国知网中外电子数据库,检索时间为2015年12月到2016年12月,检索词:"lateral lumbar interbody fusion","direct lumbar interbody fusion","extreme lateral interbody fusion","minimal invasive surgery","adult scoliosis",并根据纳入标准对相关文献进行筛查后,整理分析固定后患者的临床症状改善和影像学改变。结果与结论:最终共纳入13篇文献。侧入路椎体间融合在治疗成人退行性脊柱侧凸时,具有出血量少,住院时间短,临床症状改善明显,冠状面畸形矫正效果明显,远期并发症发生率低等优点,但同时也有融合后近期并发症发生率高,矢状面矫形效果有限等缺点。所以在使用此技术时,应使用神经监护,并且合并内固定技术已达到最好的疗效。BACKGROUND： Most of evidence-based studies include both adult degenerative scoliosis and adult idiopathic scoliosis, which lead to indirectness in the results, and suppress the promotion of the evidence.OBJECTIVE： To systematically analyze the current clinical researches, and to review the curative efficacy of lateral lumbar interbody fusion for adult degenerative scoliosis.METHODS： A computer-based research of Medline, EMBASE, CENTRAL, WanFang and CNKI databases from December 2015 to December 2016, was performed with the key words of ＂lateral lumbar interbody fusion, direct lumbar interbody fusion, extreme lateral interbody fusion, minimal invasive surgery, adult scoliosis＂. The articles were screened based on the inclusion criteria, and the clinical symptom improvement and radiological changes were analyzed.RESULTS AND CONCLUSION： Totally 13 articles were included. In the treatment of adult degenerative scoliosis, lateral lumbar interbody fusion shows less blood loss, short hospitalization time, significantly improved symptoms, satisfactory correction at the coronal plane, and low incidence of long-term complications. However, it has the poor correction at the sagittal plane and high incidence of short-term postoperative complications. Therefore, intraoperative neurologic monitoring is necessary and the combination with internal fixation has obtained good effectiveness.

关 键 词：骨科植入物 脊柱植入物 成人脊柱侧凸 退行性疾病 侧入路椎体间融合 植骨融合器 冠状面畸形 矢状面畸形 并发症 神经症状 矫形 治疗 

分 类 号：R318[医药卫生—生物医学工程]