微创经椎间孔与后路腰椎椎体间融合术治疗腰椎退行性疾病的疗效meta分析  

Minimally invasive transforaminal and posterior lumbar interbody fusion forthe treatment of lumbar degenerative diseases :a meta-analysis

作　　者：张涛[1] 徐彬[2] ZHANG Tao;XU Bin(Shanxi Medical University,Taiyuan,Shanxi 030001,China;Department of Orthopedics,The First Hospital of Shanxi Medical University,Taiyuan,Shanxi 030001,China)

机构地区：[1]山西医科大学,太原030001 [2]山西医科大学第一医院骨科,太原030001

出　　处：《重庆医学》2023年第S01期151-155,共5页Chongqing medicine

摘　　要：目的对微创经椎间孔腰椎椎体间融合术与后路腰椎椎体间融合术治疗腰椎退行性疾病的治疗效果进行系统性分析。方法从PubMed、Cochrane Library、Web of science、中国知网(CNKI)、万方、维普(VIP)中英文数据库中检索建库至2022年12月的相关文献,还辅以对所有检索到的研究和综述文章的参考文献的手动搜索。对最终纳入的文献进行质量评价后进行meta分析。结果本次研究共纳入文献11篇,总计1054例患者。与后路腰椎椎间融合相比,微创经椎间孔入路行腰椎椎体间融合的手术时间较长(MD=26.48,95%CI:9.99~42.97,P<0.01),术中出血量少(MD=-180.85,95%CI:-228.45~-133.26,P<0.01),术后引流量少(MD=-90.67,95%CI:-232.50~-51.16,P<0.01),术后住院时间较短(MD=-2.78,95%CI:-4.56~-1.00,P<0.01),术后6、12个月术后腰痛VAS评分较低(MD=-0.18,95%CI:-0.43~-0.08,P=0.02),疼痛症状较轻(MD=-0.11,95%CI:-0.30~-0.08,P=0.02),术后3个月术后腿痛VAS评分较低,疼痛症状较轻(MD=-0.22,95%CI:-0.59~-0.14),(P=0.004),术后3个月ODI评分较低,(MD=-2.72,95%CI:-6.95~-1.51,P<0.01),但术后并发症总发生率差异无统计学意义(PR=0.73,95%CI:0.40~1.36,P=0.15)。结论与后路椎间融合相比,微创经椎间孔行腰椎椎体间融合术具有术中出血少、术后引流少、术后住院时间短、术后疼痛轻、术后恢复快等优势,但手术时间较长。两种手术入路术后并发症发生情况无明显差异。Objective To systematically analyze the therapeutic effects of minimally invasive transforaminal lumbar interbody fusion and posterior lumbar interbody fusion in the treatment of lumbar degenerative diseases.Methods The relevant literatures documents were retrived from PubMed,Cochrane Library,Web of science,CNKI,Wanfang Data and VIP databases from database establishment to December 2022 by computer.It is also supplemented by manual search of references to all retrieved research and review articles.meta-analysis is conducted after quality evaluation of the finally included literature.Results A total of 11 articles with a total of 1054 patients were included in this study.Compared with posterior lumbar interbody fusion,the surgery time of minimally invasive transforaminal lumbar interbody fusion was longer(MD=26.48,95%CI:9.99-42.97,P<0.01),and the intraoperative blood loss was less(MD=-180.85,95%CI:-228.45--133.26,P<0.01).The postoperative drainage volume was low(MD=-90.67,95%CI:-232.50--51.16,P<0.01),the postoperative hospital stay was short(MD=-2.78,95%CI:-4.56--1.00,P<0.01),and the VAS score of postoperative lumbago was low 6 and 12 months after surgery(MD=-0.18,95%CI:-0.43--0.08,P=0.02),the pain symptoms were mild(MD=-0.11,95%CI:-0.30--0.08,P=0.02),the postoperative leg pain VAS score was lower and the pain symptoms were mild 3 months after surgery(MD=-0.22,95%CI:-0.59--0.14,P=0.004),ODI score was low 3 months after surgery(MD=-2.72,95%CI:-6.95--1.51,P<0.01),but there was no significant difference in the total incidence of postoperative complications(PR=0.73,95%CI:0.40-1.36,P=0.15).Conclusion Compared with posterior lumbar interbody fusion,minimally invasive lumbar interbody fusion via intervertebral foramen has the advantages of less intraoperative bleeding,less postoperative drainage,shorter postoperative hospital stay,less postoperative pain,and faster postoperative recovery,but the operation time is longer.There was no significant difference in postoperative complications between the two approaches.

关 键 词：微创经椎间孔腰椎椎体间融合术 后路腰椎椎体间融合术 腰椎退行性疾病 META分析 

分 类 号：R687.3[医药卫生—骨科学]