腰椎后路融合术后早期使用支具对患者临床结局影响的meta分析  

Postoperative bracing on clinical outcomes following posterior lumbar fusion for degenerative lumbar diseases:a meta-analysis

作　　者：韩耕愚 樊喆羽 岳立豪 邹达[1] 孙卓然[1] 李危石[1] Han Gengyu;Fan Zheyu;Yue Lihao;Zou Da;Sun Zhuoran;Li Weishi(Department of Orthopaedics,Peking University of Third Hospital Engineering Research Center of Bone and Joint Precision Medicine Ministry of Education Beijing Key Laboratory of Spinal Disease Research,Beijing 100191,China)

机构地区：[1]北京大学第三医院骨科,骨与关节精准医学教育部工程中心,脊柱疾病研究北京市重点实验室,北京100191

出　　处：《中华骨科杂志》2023年第7期445-451,共7页Chinese Journal of Orthopaedics

摘　　要：目的系统评价腰椎后路融合术后早期使用支具治疗对腰椎退变性疾病患者疼痛、功能障碍、融合率、并发症发生率等临床结局的改善是否有优势。方法在PubMed、Web of Science、Embase、中国知网、万方数据库检索发表时间为1990年1月至2022年5月的腰椎退变性疾病患者行腰椎后路融合术后使用支具治疗的随机对照研究。获取文献的作者、发表时间、国籍、受试者特征、样本量、手术方式、支具类型及配戴时间、随访时间、术前及术后随访的Oswestry功能障碍指数(Oswestry disability index,ODI)和视觉模拟评分(visual analogue scale,VAS)、术后融合率及并发症发生率。采用Cochrane偏倚风险评估工具评估偏倚风险。根据异质性大小决定使用固定或随机效应模型。数据分析应用Stata 17.0统计软件进行meta分析。结果纳入5篇随机对照研究,均为英文文献,共362例患者,男144例、女218例。Meta分析结果显示:配戴支具组和不配戴支具组在术后ODI改善情况[MD=1.25,95%CI(-2.39,4.88),P=0.501]和VAS评分改善情况[MD=0.21,95%CI(-0.22,0.63),P=0.340]方面的差异均无统计学意义;配戴支具组和不配戴支具组融合率的差异无统计学意义[OR=0.59,95%CI(0.25,1.38),P=0.224];两组术后并发症发生率的差异无统计学意义[OR=1.12,95%CI(0.58,2.15),P=0.735]。结论腰椎后路融合术后早期使用支具治疗在改善症状及功能恢复、融合率和手术并发症方面没有明显优势。腰椎术后是否需要常规使用支具治疗需进一步高质量研究证明。Objective To systematically evaluate whether the early use of bracing after posterior lumbar fusion has advantages in terms of the improvement of clinical outcomes such as pain,functional disability,fusion rate,and complication rate in patients with lumbar degenerative diseases.Methods All randomized controlled trials of bracing performed after posterior lumbar fusion in patients with lumbar degenerative diseases were searched in Pubmed,Web of Science,Embase,China national knowledge infrastructure(CNKI)and Wanfang database from January 1990 to May 2022.The data extracted were authors,year of publication,nationality,subject characteristics,sample size,surgical protocol,type and time of bracing,follow-up duration,preoperative and postoperative Oswestry disability index(ODI)and visual analogue scale(VAS),postoperative fusion rate and complication rate.The Cochrane Risk of Bias tool was used to evaluate the risk of bias.The use of fix-or random-effect models was depended on the magnitude of heterogeneity.Data analysis was performed using Stata 17.0 statistical software for meta analysis.Results A total of five randomized controlled trials were included,all in English,with a total of 362 patients(male 144,female 218).The results of meta-analysis showed that there was no statistically significant difference in the improvement of ODI scores[MD=1.25,95%CI(-2.39,4.88),P=0.501]and VAS scores[MD=0.21,95%CI(-0.22,0.63),P=0.340]between the brace group and the control group after operation.In terms of fusion rate,there was no significant difference between the brace group and the control group[OR=0.59,95%CI(0.25,1.38),P=0.224].In addition,there was also no significant difference in the incidence of postoperative complications between two groups[OR=1.12,95%CI(0.58,2.15),P=0.735].Conclusion The early use of bracing after lumbar fusion has no significant advantages in improving symptoms and functional recovery,fusion rate and surgical complications.The necessity of postoperative bracing after posterior lumbar fusion requires furt

关 键 词：腰椎 脊柱融合术 META分析 外固定器 

分 类 号：R687.3[医药卫生—骨科学]