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退变性腰椎滑脱并椎管狭窄症的融合与非融合手术的Meta分析
叶永恒,赵庆,唐宇星,等
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摘要:
目的:采用Meta分析法,比较脊柱融合与非融合两种手术治疗方式对于治疗退变性腰椎滑脱并椎管狭窄症的疗效。 方法:计算机检索数据库为:CNKI中国知网、万方数据、维普期刊、中国生物医学文献数据库、Web of Science、Pubmed、Springer-Springer Link online Journals等数据库检索平台。纳入所有关于脊柱融合与非融合治疗轻度退变性腰椎滑脱并椎管狭窄的对照试验研究。统计学分析采用RevMan4.2软件。 结果:纳入8项临床对照研究,其中2项为随机对照研究,6项为回顾性研究。共595例,其中融合组307例,非融合组288例。Meta分析发现:①平均手术时间融合组较非融合组长[MD=4.15,95%CI(-0.07,8.36),P=0.05]。②术中平均出血量融合组较非融合组多[MD=3.98,95%CI(2.12,5.84),P<0.0001]。③疗效优良率融合组较非融合组更有高[OR=1.70,95%CI(1.02,2.84),P=0.04]。④术后VAS评分融合组较非融合组改善明显[MD=-2.35,95%CI(-3.68,-1.03),P=0.0005]。⑤椎间隙高度融合组与非融合组无差异。⑥滑脱程度融合组较非融合组滑脱程度更小[MD=-1.72,95%CI(-2.76,-0.68),P=0.001]。⑦融合组较非融合组的术后并发症高[OR=2.68,95%CI(1.18,6.05),P=0.02]。 结论:融合与非融合对于治疗轻度退变性腰椎滑脱并椎管狭窄症均能取得良好的效果,融合组疗效、术后VAS评分、滑脱程度较非融合组改善明显,但手术时间、术中出血量、术后并发症均高于非融合组。总体评价融合对于改善腰椎症状及术后滑脱具有明显优势。由于纳入研究数量偏少,仍需开展和设计大样本随机对照研究的进一步验证。
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Abstract:
Purpose: Through meta analysis of fusion and non-fusion ,we evaluated the efficacy and safety of them in treat ment of lumbar stenosis with spondylolisthesis; and to provide evidence for clinical decisions of mild lumbar stenosis with spondylolisthesis. Methods: We searched database of computer and annually searched related journals in order to collect those researches for comparation of fusion and non-fusion that met the inclusion criteria,so that we coule evaluate the comparation systematicly. Results:We brought into a total of 8 literatures,including 595 cases. A total of 595 patients were identified, with 307 in the fusion procedure group and 288 in the non -fusion procedure group. Major findings from the meta-analysis showed that: 1) Operation time was significantly longer in the fusion than non-fusion procedure group [MD=4.15, 95%CI (-0.07, 8.36), P=0.05]; 2) Average amount of bleeding during the surgeries was significantly more in the fusion than non-fusion procedure group [MD=3.98, 95%CI (2.12, 5.84), P<0.00001]; 3) the fusion is more effective than non-fusion procedure group [OR=1.7-, 95%CI (1.02, 2.84), P=0.04]; 4) Post-operative VAS scoring improved more significantly in the fusion than non-fusion procedure group [MD=-2.35, 95%CI (-3.68, -1.03), P=0.00005]; 5) No statistically significant difference was observed in intervertebral space between the two groups; 6) Degree of spondylolisthesis was less severe in the fusion than non-fusion group [MD=-1.72, 95%CI (-2.76, -0.68), P=0.001]; 7) Post-operative complications were higher in the fusion than non-fusion group [OR=2.68, 95%CI (1.18, 6.05), P=0.02]. Conclusions: Both of fusion and non-fusion procedures prove to be effective in treating lumbar stenosis with spondylolisthesis. Fusion procedures showed more superiority in treatment efficacy, post operative VAS scoring, and degree of spondylolisthesis; while non-fusion procedures were more superior in surgical time, amount of heamorrhage during surgery, and post operative complications. All told, fusion procedure showed significantly better outcomes in improving lumbar syndromes and post-operative spondylolisthesis. However, findings need to be interpreted cautiously due to small sample size and more randomized controlled trials with larger sample sizes are warranted to obtain high quality of evidence.
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