退变性腰椎滑脱并椎管狭窄症的融合与非融合手术的Meta分析  

Meta-Analysis of Spinal Fusion Compared with Non-fusion for the Treatment of Lumbar Stenosis with Spondylolisthesis

作　　者：叶永恒[1] 赵庆[1] 唐宇星[1] 彭玥 杨中萌[1] 胡仁安[1] YE Yong-heng;ZHAO Qing;TANG Yu-xing;et al(Orthopedic Surgery, The Fifth Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 519000, China)

机构地区：[1]中山大学附属第五医院骨外科,广东珠海519000 [2]珠海市人民医院耳鼻喉科,广东珠海519000

出　　处：《黑龙江医学》2018年第1期15-18,共4页Heilongjiang Medical Journal

摘　　要：目的采用Meta分析法,比较脊柱融合与非融合两种手术治疗方式对于治疗退变性腰椎滑脱并椎管狭窄症的疗效。方法计算机检索数据库为:CNKI中国知网、万方数据、维普期刊、中国生物医学文献数据库、Web of Science、Pubmed、Springer-Springer Link online Journals等数据库检索平台。纳入所有关于脊柱融合与非融合治疗轻度退变性腰椎滑脱并椎管狭窄的对照试验研究。统计学分析采用Rev Man4.2软件。结果纳入8项临床对照研究,其中2项为随机对照研究,6项为回顾性研究。共595例,其中融合组307例,非融合组288例。Meta分析发现:(1)平均手术时间融合组较非融合组长[MD=4.15,95%CI(-0.07,8.36),P=0.05]。(2)术中平均出血量融合组较非融合组多[MD=3.98,95%CI(2.12,5.84),P<0.000 1]。(3)疗效优良率融合组较非融合组更高[OR=1.70,95%CI(1.02,2.84),P=0.04]。(4)术后VAS评分融合组较非融合组改善明显[MD=-2.35,95%CI(-3.68,-1.03),P=0.0005]。(5)椎间隙高度融合组与非融合组无差异。(6)滑脱程度融合组较非融合组滑脱程度更小[MD=-1.72,95%CI(-2.76,-0.68),P=0.001]。(7)融合组较非融合组的术后并发症高[OR=2.68,95%CI(1.18,6.05),P=0.02]。结论融合与非融合对于治疗轻度退变性腰椎滑脱并椎管狭窄症均能取得良好的效果,融合组疗效、术后VAS评分、滑脱程度较非融合组改善明显,但手术时间、术中出血量、术后并发症均高于非融合组。总体评价融合对于改善腰椎症状及术后滑脱具有明显优势。由于纳入研究数量偏少,仍需开展和设计大样本随机对照研究的进一步验证。Objective Through meta-analysis of fusion and non-fusion for the treatment of lumbar stenosis with spondylolisthesis. Methods Computer-based retrieval database were CNKI,Wanfang Data,CQVIP,Sino Med,Web of Science,Pubmed,Springer-Springer Link Online Journals,etc. Collecting those researches for comparison of fusion and non-fusion that met the inclusion criteria Rev Man 4. 2 software was used to do statistical analysis. Results 8 clinical researches were done,including 2 randomized controlled researches and 6 retrospective researches. A total of 595 patients were identified,with 307 in the fusion procedure group and 288 in the non-fusion procedure group. Major findings from the meta-analysis showed that：（1） Operation time was significantly longer in the fusion than non-fusion procedure group [MD = 4. 15,95% CI（-0. 07,8. 36）,P = 0. 05];（2） Average amount of bleeding during the surgeries was significantly more in the fusion than non-fusion procedure group [MD = 3. 98,95% CI（2. 12,5. 84）,P 〈0. 000 1];（3） Excellent and good rate of the fusion was more than non-fusion procedure group [OR = 1. 70,95% CI（1. 02,2. 84）,P = 0. 04];（4） Post-operative VAS scoring improved more significantly in the fusion than non-fusion procedure group [MD =-2. 35,95% CI（-3. 68,-1. 03）,P = 0. 0005];（5） No statistically significant difference was observed in intervertebral space between the two groups;（6）Degree of spondylolisthesis was less severe in fusion than non-fusion group [MD =-1. 72,95% CI（-2. 76,-0. 68）,P = 0. 001];（7） Post-operative complications were higher in the fusion than non-fusion group [OR = 2. 68,95% CI（1. 18,6. 05）,P = 0. 02]. Conclusion Both of fusion and non-fusion procedures prove to be effective in treating lumbar stenosis with spondylolisthesis. Fusion procedures show more superiority in treatment efficacy,post operative VAS scoring,and degree of spondylolisthesis; while non-fusion procedures are more superior in surgical time,amount of heamorrhage during surgery,

关 键 词：退变性腰椎滑脱 腰椎管狭窄 腰椎不稳 腰椎椎间融合 腰椎椎间非融合 动态固定 棘突成形术 

分 类 号：R681.57[医药卫生—骨科学]