斜外侧腰椎椎间融合术治疗退变性脊柱侧凸疗效的meta分析  

The efficacy of oblique lateral lumbar interbody fusion in the treatment of degenerative scoliosis:a meta-analysis

作　　者：王国泰 冯皓宇[1] 吴华 Wang Guotai;Feng Haoyu;Wu Hua(Department of Orthopaedics,Third Hospital of Shanxi Medical University(Shanxi Bethune Hospital,Shanxi Academy of Medical Sciences,Tongji Shanxi Hospital),Taiyuan 030032,China)

机构地区：[1]山西医科大学第三医院(山西白求恩医院,山西医学科学院,同济山西医院)骨科,太原030032

出　　处：《中华骨科杂志》2025年第4期222-229,共8页Chinese Journal of Orthopaedics

基　　金：国家重点研发计划(2022YFC3601900)。

摘　　要：目的分析斜外侧腰椎椎间融合术(oblique lumbar interbody fusion,OLIF)治疗退变性脊柱侧凸的临床疗效。方法检索中国知网、万方数据知识服务平台、维普和中华医学期刊全文数据库、Pubmed、Embase、Web of Science、Google Scholar数据库中OLIF治疗退变性脊柱侧凸的临床研究,检索时间从建库至2024年5月。提取疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)、冠状面侧凸Cobb角、骨盆倾斜角(pelvic tilt,PT)、腰椎前凸角(lumbar lordosis,LL)、矢状面平衡(sagittal vertical axis,SVA),比较手术前后指标的变化。采用非随机研究方法学指数(methodological index for non-randomized studies,MINORS)对纳入文献进行质量评价。采用Stata18.0统计学软件进行meta分析。组间异质性较小时采用固定效应模型进行分析,组间异质性较大时采用随机效应模型进行分析。结果共7篇文献的152例患者纳入meta分析,其中中文文献3篇、英文文献4篇,MINORS评分17~22分。Meta分析结果显示OLIF治疗退变性脊柱侧凸能够有效降低术后VAS评分[SMD=-4.74,95%CI(-5.26,-4.21),P<0.001]、ODI[SMD=-6.21,95%CI(-8.02,-4.41),P<0.001]、冠状面侧凸Cobb角[SMD=-2.50,95%CI(-3.22,-1.78),P<0.001]、PT[SMD=-0.73,95%CI(-1.14,-0.33),P<0.001]、SVA[SMD=-1.01,95%CI(-1.75,-0.28),P=0.007],并显著提高术后LL[SMD=1.16,95%CI(0.65,1.68),P<0.001]。结论OLIF治疗退变性脊柱侧凸可有效缓解疼痛、改善脊柱功能、矫正冠状面侧凸畸形。Objective To analyze the clinical efficacy of oblique lumbar interbody fusion(OLIF)in the treatment of degenerative scoliosis.Methods The clinical studies of OLIF in the treatment of degenerative scoliosis published up to May 2024 were searched in China National Knowledge Infrastructure(CNKI),Wanfang Data Knowledge Service Platform,VIP,Chinese Medical Journal Full-text Database,PubMed,Embase,Web of Science,and Google Scholar databases.Visual analogue scale(VAS),Oswestry disability index(ODI),Cobb's angle of coronal convexity,pelvic tilt(PT),lumbar lordosis(LL),sagittal vertical axis(SVA)were extracted to compare the changes of the indexes before and after surgery.The methodological index for non-randomised studies(MINORS)was used to evaluate the quality of the included literature.Stata 18.0 statistical software was used for the meta-analysis.When the heterogeneity between groups was small,the fixed-effect model was used for analysis,and when the heterogeneity between groups was large,the random-effect model was used for analysis.ResultsA total of 152 patients from 7 articles were included in the meta-analysis,including 3 in Chinese and 4 in English,with MINORS scores ranging from 17 to 22.Meta-analysis showed that OLIF for treating degenerative scoliosis was effective in reducing postoperative VAS score[SMD=-4.74,95%CI(-5.26,-4.21),P<0.001],ODI[SMD=-6.21,95%CI(-8.02,-4.41),P<0.001],coronal plane scoliosis Cobb angle[SMD=-2.50,95%CI(-3.22,-1.78),P<0.001],PT[SMD=-0.73,95%CI(-1.14,-0.33),P<0.001],and SVA[SMD=-1.01,95%CI(-1.75,-0.28),P=0.007],and significantly improved postoperative LL[SMD=1.16,95%CI(0.65,1.68),P<0.001].Conclusion OLIF for treating degenerative scoliosis can effectively relieve pain,improve spinal function,and correct coronal facet scoliosis deformity.

关 键 词：脊柱侧凸 减压术 外科 脊柱融合术 META分析 

分 类 号：R687.3[医药卫生—骨科学]