MIS-TLIF术单侧与双侧内固定临床效果比较的Meta分析

目的 :比较MIS-TLIF手术单侧与双侧螺钉内固定治疗腰椎退行性疾病的临床效果。方法:计算机检索Medline、EMbase、The Cochrane Library、中国生物医学文献数据库、万方数据库、中国知网等中英文数据库2000年1月至2015年10月关于MIS-TLIF手术单侧与双侧内固定治疗腰椎退行性疾病的临床研究。对纳入的文献进行资料提取,根据Cachrane handbook 5.1.0对纳入的随机对照研究(RCT)进行质量评价,根据MINORS评价方法对纳入的回顾性或前瞻性研究进行方法学质量评价,采用Rev Man 5.2.0软件对疼痛视觉模拟(VAS)评分、Oswestry功能障碍指数(ODI)评分、腰椎前凸角、节段前凸角、腰椎侧凸角、节段侧凸角、融合率、并发症发生率、手术时间、失血量、住院时间等指标进行Meta分析。结果:共纳入9篇研究,451例患者,其中随机对照研究4篇,前瞻性研究2篇,回顾性研究3篇。Meta分析结果显示:单侧固定组与双侧固定组比较,VAS腰痛评分、VAS下肢痛评分、ODI、腰椎前凸角、节段前凸角、腰椎侧凸角、节段侧凸角、融合率、并发症发生率及住院时间的差异均无统计学意义;手术时间及术中失血量差异有统计学意义。结论:MIS-TLIF术中单侧固定与双侧固定治疗腰椎退行性疾病的临床效果相当,两种固定方式的并发症发生率也无差异,同时单侧固定由于手术时间短、失血少等原因具有更好的安全性。由于纳入文献的方法学质量不高、样本量较小、评价指标较主观、随访时间短、存在临床异质性等原因,结论尚需进一步研究明确。

Unilateral versus bilateral pedicle screw fixation in minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF): a Meta analysis

Objective:To compare the clinical outcome between unilateral and bilateral pedicle screw fixation in minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) for the treatment of lumbar degenerative diseases.Methods:The studies concerning unilateral or bilateral pedicle screw fixation in MIS-TLIF for the treatment of lumbar degenerative diseases from January 2000 to October 2015 were searched from Medline,Embase,The Cochrane Library,China Biology Medicinedisc and Wanfang database,China National Knowledge Internet (CNKI). The data of the studies were collected,risk of bias of the included RCTs were assessed according to Cochrane handbook 5.1.0,risk of bias of the included retrospective or prospective studies were assessed according to MINORS. The Oswestry Disability Index (ODI),visual analogue scale(VAS),lumbar lordosis angle,segmental lordosis angle,lumbar scoliosis angle,segmental scoliosis angle,fusion rate,complication rate,hospitalization time,operative time and blood loss data were Meta-analyzed by RevMan 5.2.0 software.Results:Nine studies were included,containing 4 randomized controlled trials (RCT),2 prospective studies and 3 retrospective studies,there were 451 patients in total. The results showed that there was no significant difference between the two methods in VAS of back pain,VAS of leg pain,ODI,lumbar lordosis angle,segmental lordosis angle,lumbar scoliosis angle,segmental scoliosis angle,fusion rate,complication rate,hospitalization time. There was significant difference in operative time and blood loss between unilateral and bilateral pedicle screw fixation.Conclusion:Using unilateral or bilateral pedicle screw fixation in MIS-TLIF for lumbar degenerative diseases can achieve the same clinical effects,and there was no significant difference in complication rate. Unilateral pedicle screw fixation is safer than bilateral fixation because of less operative time and blood loss. However,the number and quality of the literatures may result in low reliability,so greater sample size and high-quality RCTs are needed in future.