后路环形融合和后外侧融合治疗腰椎滑脱症的Meta分析  

Posterior Circumferential Fusion and Posterolateral Fusion for Lumbar Spondylolisthesis: A Meta Analysis

作　　者：梁龙 银河[1] 于杰[1] 高景华[1] 冯敏山[1,2] 杨克新 尹逊路[1] 朱立国 LIANG Long;YIN He;YU Jie;GAO Jing-hua;FENG Min-shan;YANG Ke-xin;YIN Xun-lu;ZHU Li-guo(Department of Spinal Surgery,Wangjing Hospital Affiliated to Chinese Academy of TCM,Beijing 100102,China;Beijing Key LaboratoU of Traditional Chinese Orthopedics,Beijing 100102,China)

机构地区：[1]中国中医科学院望京医院脊柱二科,北京市100102 [2]中医正骨技术北京市重点实验室,北京市100102

出　　处：《中国现代手术学杂志》2018年第2期95-102,共8页Chinese Journal of Modern Operative Surgery

基　　金：十二五国家科技支撑计划(编号:2014BAI08B006);国家行业专项课题(编号:201107004)

摘　　要：目的评价后路环形融合和后外侧融合治疗腰椎滑脱症的临床疗效。方法检索国内所有关于后路环形融合和后外侧融合治疗腰椎滑脱症的临床对照试验。由2名评价者独立对纳入的文献进行数据提取后,用Rev Man 5.3软件进行Meta分析。结果按照规定的文献检索方式,最终纳入12篇文献,共纳入患者759例,分析结果显示:后路环形融合组与后外侧融合比较,其优良率[OR=2.36,95%CI(1.33,4.17)],P=0.003,两者差异具有统计学意义。同时,在改善融合率、随访时椎间隙高度、手术时间和出血量方面差异均有统计学差异,在改善腰椎滑脱角和术后即刻椎间隙高度方面,两种方式差异无明显统计学意义。绘制倒漏斗图,结果显示倒漏斗图基本对称,提示发表偏倚尚可。结论与后外侧融合相比,后路环形融合在改善优良率、融合率和椎间隙高度方面有着一定优势,但手术时间及出血量较多。两者对于改善腰椎前凸角的效果没有差异。Objective To evaluate the clinical efficacy of posterior circumferential fusion and posterolateral fusion in the treatment of lumbar spondylolisthesis. Methods All clinical trials of posterior circumferential fusion and posterolateral fusion for lumbar spondylolisthesis were retrieved. Then information was extracted effectively by two evaluators independently,and was analyzed by the Rev Man 5. 3 software. Results In accordance with the provisions of the literature retrieval,finally 12 articles with 759 patients were included in the study. Analysis results showed that the pooled OR and 95% confidence interval for the superior rate was [OR= 2. 36,95% CI（ 1. 33,4. 17） ],P = 0. 003. In the aspect of improving the fusion rate,intervertebral height during operation,operation time and amount of bleeding,there were significant differences. But in improving lumbar lordosis and the height of postoperative intervertebral space,there was no significant difference between the two ways. The result showed that the funnel plot was basically symmetrical,suggesting that the publication bias was still available. Conclusion Compared with posterolateral fusion,posterior circumferential fusion has advantages in improving superior rate,the rate of fusion and the height of intervertebral space,but results in more operative time and bleeding volume. Finally,for the improvement of lumbar lordosis,there＇re no difference between the two groups.

关 键 词：腰椎滑脱症 后路环形融合 后外侧融合 META分析 

分 类 号：R681.5[医药卫生—骨科学]