斜外侧腰椎椎间融合术与经椎间孔腰椎椎间融合术治疗退行性腰椎滑脱临床疗效比较的Meta分析  

Meta-analysis of clinical efficacy comparison between oblique lateral interbody fusion and transforaminal lumbar interbody fusion in the treatment of degenerative lumbar spondylolisthesis

作　　者：张毅[1] 张慧[1] 唐本夫[1] Zhang Yi;Zhang Hui;Tang Benfu(Hunan University of Chinese Medicine,Changsha Hunan 410208)

机构地区：[1]湖南中医药大学,湖南长沙410208

出　　处：《山西中医药大学学报》2023年第6期613-621,共9页Journal of Shanxi University of Chinese Medicine

基　　金：2021年度湖南中医药大学研究生创新课题(2021CX34)。

摘　　要：目的:系统评价斜外侧腰椎椎间融合术(OLIF)与经椎间孔腰椎椎间融合术(TLIF)治疗退行性腰椎滑脱的近期临床疗效。方法:系统检索CNKI、Cochrane library、PubMed、Embase等数据库,检索时间均为建库至2021年5月,研究对象为单节段退行性腰椎滑脱患者,使用RevMan 5.4软件对OLIF与TLIF治疗腰椎滑脱的临床疗效进行Meta分析。研究指标包括:手术持续时间、术中出血量、住院时长、术前及术后的视觉模拟评分(VAS)与Oswestry功能障碍指数(ODI)评分、术后椎间隙高度与椎间孔高度、术中及术后早期并发症、术后末次随访时腰椎融合率。采用SPSS 22.0统计学软件对各类并发症进行统计分析,组间采用卡方检验。结果:通过筛选,本系统分析共纳入7项研究,其中随机对照研究1项,队列研究6项,共369例患者(OLIF组171例,TLIF组198例)。Meta分析表明:相较于TLIF,OLIF的手术时间、术中出血量、住院时长、术后末次ODI均低于TLIF术,OLIF术的术后椎间隙高度与椎间孔高度比TLIF术恢复的更好,差异均具有统计学意义;但两组的术前VAS与ODI评分、术后末次VAS评分、术中及术后早期并发症发生率和术后融合率比较,差异无统计学意义;术后伤口感染、硬脑膜撕裂与脑脊液漏比较,均具有统计学意义。结论:OLIF与TLIF治疗单节段退行性腰椎滑脱均能取得良好的临床疗效,但OLIF的手术时间、术中出血量及住院时间较TLIF更短,术后椎间隙与椎间孔高度较TLIF恢复得更好,OLIF发生术后伤口感染、硬脑膜撕裂与脑脊液漏的可能性更低,具有更大的优势。Objective:To systematically evaluate the short-term clinical efficacy of oblique lateral interbody fusion(OLIF) and transforaminal lumbar interbody fusion(TLIF) in the treatment of degenerative lumbar spondylolisthesis.Methods:CNKI,Cochrane library,PubMed,Embase and other databases were systematically searched.The retrieval time was from the establishment of the database to May 2021.The study objects were patients with single segment degenerative lumbar spondylolisthesis.The clinical efficacy of OLIF and TLIF in the treatment of lumbar spondylolisthesis was analyzed by using RevMan 5.4 software.The study index included:duration of surgery,intraoperative blood loss,length of hospital stay,preoperative and postoperative visual analogue scale(VAS) and oswestry disability index(ODI) scores,postoperative disc space height and intervertebral foramen height,intraoperative and early postoperative complications,and lumbar fusion rate at the last postoperative follow-up.SPSS 22.0 statistical software was used for statistical analysis of various complications,and chi-square test was used between groups.Results:After screening,7 studies were included in this systematic analysis,including 1 randomized controlled study and 6 cohort studies,with a total of 369 patients(171 in OLIF group and 198 in TLIF group).Meta-analysis showed that compared with TLIF,OLIF had lower surgery time,intraoperative blood loss,length of hospital stay,and final postoperative ODI than TLIF.OLIF had better recovery of postoperative disc space height and intervertebral foramen height than TLIF,and the differences were statistically significant.However,there were no significant differences in preoperative VAS and ODI scores,last postoperative VAS scores,intraoperative and early postoperative complications rates and postoperative fusion rates between the two groups.Postoperative wound infection,dural tear and cerebrospinal fluid leakage were statistically significant.Conclusion:Both OLIF and TLIF can achieve good clinical efficacy in the treatment of sin

关 键 词：腰椎滑脱 斜外侧腰椎椎间融合术 经椎间孔椎间融合术 META分析 

分 类 号：R687.3[医药卫生—骨科学]