超声骨刀辅助腰椎后路椎体间融合术治疗腰椎管狭窄症的荟萃分析  

Meta-analysis of posterior lumber interbody fusion in the treatment of lumbar spinal stenosis

作　　者：王思敏 郭天赐 杨家麟 刘佳进 麻志廷 崔航 刘爱峰[1] WANG Simin;GUO Tianci;YANG Jialin;LIU Jiajin;MA Zhiting;CUI Hang;LIU Aifeng(Department of Orthopedics and Traumatology,First Teaching Hospital of Tianjin University of Traditional Chinese Medicine,National Clinical Research Center of Chinese Medicine Acupuncture and Moxibustion,Tianjin 300381;Graduate School,Tianjin University of Traditional Chinese Medicine,Tianjin 301617)

机构地区：[1]天津中医药大学第一附属医院骨伤科、国家中医针灸临床医学研究中心,天津300381 [2]天津中医药大学研究生院,天津301617

出　　处：《颈腰痛杂志》2025年第1期116-125,共10页The Journal of Cervicodynia and Lumbodynia

基　　金：天津市科技计划项目(21KPXMRC00050);天津市津门医学英才项目(TJSJMYXYC-D2-028)。

摘　　要：目的系统评价超声骨刀辅助腰椎后路椎体间融合术(PLIF)治疗腰椎管狭窄症(LSS)的有效性与安全性。方法检索中国知网、万方数据、维普、中国生物医学文献数据库、PubMed、Embase、Cochrane Library及Web of Science数据库,收集各数据库建库至2023年1月有关超声骨刀辅助PLIF治疗LSS的临床研究,由2名研究者独立进行文献筛选、资料提取、数据核对及质量评价,结局指标使用RevMan 5.4软件进行荟萃分析。结果①共纳入12篇文献,其中4篇随机对照试验,8篇回顾性队列研究;共涉及1069例患者,试验组559例,对照组510例;②荟萃分析结果显示:与传统器械组相比,超声骨刀组能显著改善视觉模拟评分法(VAS)评分[MD=-0.41,95%CI(-0.60,-0.23),P<0.00001]和Oswestry功能障碍指数(ODI)评分[MD=-1.50,95%CI(-2.31,-0.69),P=0.0003],降低术中出血量[MD=-60.05,95%CI(-72.51,-47.59),P<0.00001]和并发症发生率[RR=0.29,95%CI(0.16,0.52),P<0.0001],缩短椎板切除时间[MD=-1.51,95%CI(-2.48,-0.54),P=0.002]。结论超声骨刀辅助PLIF手术在降低VAS、ODI、术中出血量及并发症发生率、缩短椎板切除时间方面均有显著优势。Objective To systematically evaluate the efficacy and safety of ultrasonic bone knife-assisted posterior lumber interbody fusion(PLIF)in the treatment of lumbar spinal stenosis(LSS).Methods The data of CNKI,Wanfang,VIP,CBM,PubMed,Embase,Cochrane Library and Web of Science were searched,the clinical study of LSS in January 2023 was collected,literature screening,data extraction,data verification and quality evaluation were performed by 2 investigators according to the inclusion and exclusion criteria,and the Meta-analysis of the outcome measures was performed with RevMan 5.4 software.Results①There were 12 articles totally,which included 4 randomized controlled trials(RCT)and 8 retrospective cohort studies(RCS);there were 1069 patients in total,559 patients in the test group,510 cases of the control group;②Meta-analysis results showed that,compared to the conventional device group,the ultrasonic bone knife group significantly improved the visual analogue scale(VAS)score[MD=-0.41,95%CI(-0.60,-0.23),P<0.00001]and Oswestry disability index(ODI)score[MD=-1.50,95%CI(-2.31,-0.69),P=0.0003],reduced the intraoperative blood loss[MD=-60.05,95%CI(-72.51,-47.59),P<0.00001]and complication rate[RR=0.29,95%CI(0.16,0.52),P<0.0001],and shortened the time of laminectomy[MD=-1.51,95%CI(-2.48,-0.54),P=0.002].Conclusion The results of this study suggest that ultrasonic bone knife-assisted PLIF has significant advantages in reducing VAS,ODI,intraoperative bleeding and complication rate,and shortening the time of laminectomy.

关 键 词：超声骨刀 腰椎后路椎体间融合术 腰椎管狭窄症 随机对照试验 队列研究 荟萃分析 

分 类 号：R682.3[医药卫生—骨科学]