摘要
目的:系统评价经椎间孔入路与传统后正中入路手术治疗腰椎退行性疾病(lumbar degenerative diseases,LDD)的疗效及安全性。方法:利用计算机检索The Cochrane Library,Pub Med,EMbase,MEDLINE,SCI,中国知网,中国生物医学文献数据库及万方数据库,检索文献的发表日期截至2014年2月;收集采用微创Wiltse入路经椎间孔减压植骨融合手术(transforaminal lumbar interbody fusion,TLIF)与采用传统正中入路椎板切除减压椎间植骨融合手术(posterior lumbar interbody fusion,PLIF)治疗LDD的随机或非随机同期对照试验。由2名评价者按照纳入与排除标准选择试验、提取资料和评价质量后,采用Rev Man 5.2软件进行Meta分析。结果:纳入7个随机对照试验,8个非随机对照试验,共1 127例患者。Meta分析结果显示:腰痛视觉模拟评分法[均数差(mean diff erence,MD)=-0.54,95%CI(-0.79,-0.29),P<0.001],Oswestry功能障碍指数[MD=-4.20,95%CI(-6.16,-2.25),P<0.001],术中出血量[MD=-170.98,95%CI(-225.10,-116.85),P<0.001],手术时间[MD=2.57,95%CI(-9.07,14.20),P=0.67],住院时间[MD=-3.08,95%CI(-3.03,-1.57),P=0.0003]在两组之间差异均有统计学意义。结论:治疗LDD,TLIF较之PLIF,具有出血少、术后住院时间短、腰背痛残留率低、功能恢复好,但手术时间无差别的优点。因此,在严格掌握Wiltse-TLIF治疗LDD适应证的前提下,采用Wiltse-TLIF能更好地解决LDD患者的病痛。
Objective: To systematically evaluate the effectiveness and safety of transforaminal lumbar interbody fusion(TLIF) versus posterior lumbar interbody fusion(PLIF) for lumbar degenerative diseases(LDD).Methods: Databases including The Cochrane Library, PubM ed, EMbase,MEDLINE, SCI, CNKI, CBM, Wan Fang Data were searched to collect the randomized controlled trails(RCTs) and non-RCTs regarding TLIF versus PLIF for LDD. The retrieval time was from early available time to February 2014. The search was followed the inclusion and exclusion criteria. The data were collected and evaluated by 2 reviewers independently. The Meta analysis was conducted by using RevM an 5.2 software.Results: A total of 7 RCTs and 8 non-RCTs involving 1 127 patients were included. The results of Meta-analysis showed that there were significant difference in visual analog score(VAS) [MD=-0.54, 95%CI(-0.79,-0.29), P<0.001], Oswestry disability index(ODI) [MD=-4.20, 95%CI(-6.16,-2.25), P<0.001], intraoperative blood [MD=-170.98, 95%CI(-225.10,-116.85), P<0.001], duration of operation [MD=3.18, 95%CI(-8.21, 14.56), P=0.58] and Hospital stays [MD=-3.08, 95%CI(-3.03,-1.57), P=0.0003] between the PLIF and WiltseTLIF groups.Conclusion: Wiltse-TLIF is superior to PLIF in treating LDD, with less operative blood loss, shorter hospital stays and lower postoperative complications. Thus, Wiltse-TLIF is safe and feasible for treating LDD as the indications are under strict control.
出处
《中南大学学报（医学版）》
CAS
CSCD
北大核心
2015年第1期90-101,共12页
Journal of Central South University ：Medical Science
