UBE-TLIF与MIS-TLIF治疗腰椎退行性疾病的临床疗效及预后的Meta分析  

Meta-analysis of the clinical efficacy and prognosis of UBE-TLIF and MIS-TLIF in the treatment of degenerative lumbar diseases

作　　者：王鑫 周琰杰 徐海涛[1] 刘君 李波[1] WANG Xin;ZHOU Yan-jie;XU Hai-tao;LIU Jun;LI Bo(Department of Spinal Surgery,Chongqing Medical University Afiliated Yongchuan Hospital,Chongqing,402560,China)

机构地区：[1]重庆医科大学附属永川医院脊柱外科,402560

出　　处：《中国骨与关节杂志》2025年第4期366-381,共16页Chinese Journal of Bone and Joint

摘　　要：目的比较单侧双通道内镜下腰椎椎间融合术(unilateral biportal endoscopic transforaminal lumbar interbody fusion,UBE-TLIF)与微创通道下腰椎椎间融合术(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)治疗腰椎退行性疾病的临床疗效及预后。方法通过检索包括PubMed、Embase、Web of Science、中国知网、万方数据库等中英文数据库,收集自建库以来至2024年5月UBE-TLIF与MIS-TLIF治疗腰椎退行性疾病的临床对照研究。全面提取每项研究中的观察指标,包括疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)、平均手术时间、术中失血量、术后引流量、术前与术后HB、融合率和并发症等,分析所纳入文献的质量并采用RevMan 5.4软件进行Meta分析。结果共纳入15篇文献,总样本量1077例,其中503例行UBE-TLIF,574例行MIS-TLIF。Meta分析结果表明:UBE-TLIF组和MIS-TLIF组在术后背部VAS评分、术后ODI、平均手术时间、术中失血量、预估失血量、术后引流量、总失血量、术后感染率方面差异均有统计学意义(P均<0.05)。两者在术后腿部VAS评分、术前与术后HB、融合率、其它术后并发症等方面差异均无统计学意义(P均≥0.05)。结论与MIS-TLIF组相比,UBE-TLIF组术中失血量、预估失血量、术后引流量、总失血量均更低,术后恢复更快,住院时间更短,术后感染率更低,但其手术时间更长。与当今的主流手术MIS-TLIF相比,UBE-TLIF具有创伤更小、侵入性更低的优点,使其成为治疗腰椎退行性疾病的又一可靠手术选择。Objective To compare the clinical efficacy and prognosis of unilateral biportal endoscopic lumbar interbody fusion(UBE-TLIF)and minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)in the treatment of degenerative lumbar diseases.Methods Conduct a comparative clinical study on the treatment of degenerative lumbar diseases with UBE-TLIF and MIS-TLIF from the establishment of our database to May 2024,by searching English and Chinese databases including PubMed,Embase,Web of Science,CNKI,and Wanfang Database.Extract observation indicators from each study comprehensively,including VAS,ODI,average operation time,intraoperative blood loss,postoperative drainage volume,preoperative and postoperative HB,fusion rate,complications,etc.,and analyze the quality of the included literature.Meta-analysis was conducted using RevMan 5.4 software.Results A total of 15 studies with 1077 participants were included,containing 503 cases undergoing UBE-TLIFand 574 cases undergoing MIS-TLIF.The results of meta-analysis showed that there were statistically significant differences between the UBE-TLIF group and the MIS-TLIF group in postoperative back VAS score,postoperative ODI score,average operation time,intraoperative blood loss,estimated blood loss,postoperative drainage,total blood loss,and postoperative infection rate(all P<0.05).There were no statistically significant differences between the two groups in postoperative leg VAS score,preoperative and postoperative HB,fusion rate,and other postoperative complications(all P≥0.05).Conclusions Compared with the MIS-TLIF group,the UBE-TLIF group had lower intraoperative blood loss,lower estimated blood loss,lower postoperative drainage,lower total blood loss,lower postoperative infection rate,faster postoperative recovery,shorter hospital stay,but longer operation time.Compared with the mainstream surgery MIS-TLIF,UBE-TLIF has the advantages of less trauma and lower invasiveness,making it another reliable surgical option for the treatment of degenerative lumbar diseases.

关 键 词：最小侵入性外科手术 脊柱融合术 腰椎 内窥镜 META分析 

分 类 号：R681.5[医药卫生—骨科学]