单侧双通道内镜技术辅助腰椎融合术的Meta分析  

A Meta-Analysis of Unilateral Biportal Endoscopic Lumbar Interbody Fusion

作　　者：邹焱 高子茏 张宇[1] 何跃 陈果 姚晓克[1] 邓书华 顾祖超[1] Zou Yan;Gao Zilong;Zhang Yu(Department of Orthopedics,Chengdu First People′s Hospital,Chengdu,Sichuan 610041,China)

机构地区：[1]成都市第一人民医院骨科,四川成都610041

出　　处：《四川医学》2023年第3期291-298,共8页Sichuan Medical Journal

摘　　要：目的 系统评价单侧双通道内镜技术辅助腰椎融合术(ULIF)的有效性与安全性,为ULIF在临床中的推广应用提供循证医学证据。方法 检索PubMed、Cochrane、Embase、Web of Science、中国生物医学文献数据库、中国知网、万方数据库和维普数据库,检索所有ULIF与常规腰椎融合手术的对照研究,检索时限均为建库至2022年11月4日,采用RevMan 5.3软件进行Meta分析,采用Stata 14.0软件Egger’s test分析发表偏倚。结果 最终纳入11篇文献,共纳入患者927例,其中ULIF组425例,常规组502例。Meta分析结果显示:与常规组相比,ULIF组的手术时间长[WMD=22.62,95%CI(16.65,28.60),P<0.00001];术后24 h引流量少[WMD=-101.36,95%CI(-168.47,-34.25),P=0.003];VAS腰痛1~2周和末次随访评分较低,分别为[WMD=-0.83,95%CI(-1.43,-0.23),P=0.007]和[WMD=-0.15,95%CI(-0.28,-0.03),P=0.02];VAS腿痛1~3月评分较低[WMD=-0.17,95%CI(-0.35,0.01),P=0.07];ODI评分1~2周、1~3月及末次随访均较低,分别为[WMD=-3.50,95%CI(-5.79,-1.21),P=0.003]、[WMD=-2.70,95%CI(-3.87,-1.52),P<0.00001]和[WMD=-0.60,95%CI(-1.10,-0.10),P=0.02];住院时间、VAS腰痛1~3月评分、VAS腿痛1~2周和末次随访评分、改良MacNab评分、融合率、并发症等方面无明显差异(P>0.05)。结论 当前证据表明,ULIF与常规腰椎融合术具有同等的安全性及有效性,并且在减少组织损伤、降低出血量、术后早期减轻患者腰腿疼痛方面具有显著优势。Objective The effectiveness and safety of unilateral biportal endoscopic lumbar interbody fusion(ULIF)were systematically evaluated.Methods We searched PubMed,Cochrane,Embase,Web of Science,CBM,CNKI,Wanfang database and VIP database,and searched all the controlled studies of ULIF and conventional lumbar fusion surgery,with the retrieval period from the establishment of the database to November 4,2022.RevMan 5.3 software was used for Meta analysis and Stata14.0 software Egger s test was used to analyze publication bias.Results A total of 11 literatures were included,including a total of 927 patients,including 425 patients in the ULIF group and 502 patients in the routine group.The results of Meta-analysis showed that comparing with the conventional routine group,the ULIF group had a longer operation time[WMD=22.62,95%CI(16.65,28.60),P<0.00001].Low estimated blood loss 24 h after operation[WMD=-101.36,95%CI(-168.47,-34.25),P=0.003];The VAS-Back at 1~2 weeks and the last follow-up were lower[WMD=-0.83,95%CI(-1.43,-0.23),P=0.007]and[WMD=-0.15,95%CI(-0.28,-0.03),P=0.02].The VAS-leg from 1 to 3 months was lower[WMD=-0.17,95%CI(-0.35,0.01),P=0.07].ODI was lower at 1~2 weeks,1~3 months and the last follow-up,and was[WMD=-3.50,95%CI(-5.79,-1.21),P=0.003],[WMD=-2.70,95%CI(-3.87,-1.52),P<0.00001]and[WMD=-0.60,95%CI(-1.10,-0.10),P=0.02];There were no significant differences in length of hospital stay,VAS-Back from 1 to 3 months,VAS-leg from 1 to 2 weeks and the last follow-up,modified MacNab score,fusion rate and complications(P>0.05).Conclusion Current evidence indicates that ULIF has the same safety and effectiveness as routine lumbar fusion,and has significant advantages in reducing tissue damage,blood loss,and alleviating patients back and leg pain early after surgery.

关 键 词：内镜 脊柱 腰椎 融合 META分析 

分 类 号：R687.3[医药卫生—骨科学]