腰椎后路椎间融合与后外侧融合治疗腰椎退行性疾病疗效比较的meta分析

Meta-analysis of lumbar posterolateral fusion versus posterior lumbar interbody fusion in the treatment of the degenerative lumbar disease

摘要:

目的 系统评价后外侧融合与后路椎体间融合两种融合方式治疗腰椎退行性疾病的疗效。方法 按Cochrane系统评价方法, 计算机检索Cochrane图书馆（2012年第1期）、Medline（1966～2012.3）、EMBASE（1988～2012.3）、中国生物医学文摘数据库（1986～2012.4）, 并手工检索相关杂志收集后外侧融合与后路椎体间融合治疗腰椎退行性疾病疗效对比的随机对照试验。评价纳入研究的方法学质量, 采用RevMan5软件进行Meta分析。结果 纳入4篇随机对照试验, 共329例腰椎退行性疾病患者。Meta分析结果显示, 后路椎间融合组术中及术后24 h总出血量明显少于后外侧融合组[加权均数差值（WMD）320.03, 95%CI 241.26～398.79], 差异有统计学意义（P＜0.00001）。后路椎间融合组融合率高于后外侧融合组（OR 0.41, 95%CI 0.19～0.85）, 差异有统计学意义（P = 0.02）。后路椎间融合组对腰背痛缓解优于后外侧融合组（WMD 0.43, 95%CI 0.10～0.76）, 差异有统计学意义（P = 0.01）。两组Oswestry功能障碍指数（WMD 2.86, 95%CI －0.56～6.26）、术后腿痛视觉疼痛评分（WMD 0.34, 95%CI －0.11～0.79）、术后腰椎前凸角度（WMD －2.43, 95%CI －5.42～0.55）差异均无统计学意义。结论 在治疗腰椎退行性疾病中, 后路椎间融合组较后外侧融合组有更高的融合率, 能更好的缓解腰部疼痛, 且术中及术后24 h内总出血量少。但仍需要设计良好、方法学质量更高的随机对照试验进一步验证。

Abstract:

Objective To evaluate the efficacy of lumbar posterolateral fusion(PLF) versus posterior lumbar interbody fusion(PLIF) in the treatment of the degenerative lumbar disease. Methods We searched Medline(1966 to March, 2012), Embase(1984 to March, 2012), Cochrane Central Register of Controlled Trial(1th Quarter 2012), Current Controlled Trials, The China Biological Medicine Database (1984 to March, 2012), and several related journals. The qua1ity of included trials was evaluated. Data were extracted by two reviewers independently with a designed extraction form. RevMan 5.0 software was used for data analysis. Results Four studies involving 329 patients were included. The results of meta-analysis indicated that in the fusion rate(OR 0.41, 95%CI 0.19-0.85, P=0.02) and back pain visual analogue scale(VAS) (WMD 0.43,95%CI 0.10-0.76, P=0.01), PLIF group was significantly better than PLF group. Blood lost during operation and during the 1st postoperative day was significantly less in PLIF group than in PLF group (WMD 320.03, 95%CI 241.26-398.79, P＜0.00001). There were no statistically significant differences in the Oswestry disability index(WMD 2.86, 95%CI -0.56-6.26, P=0.1), leg pain VAS(WMD 0.34, 95%CI -0.11-0.79, P = 0.13) and lumbar lordotic angle (WMD -2.43, 95%CI -5.42 -0.55), P = 0.11). Conclusions To compare with PLF, PLIF has the advantages of less blood loss, higher fusion rate, and better back pain relief. More high quality large-scale randomized controlled trials are required.