单纯植骨和椎间融合器植骨治疗退行性腰椎疾病临床疗效和安全性的Meta分析

[摘要] 目的 通过Meta分析，比较单纯植骨和椎间融合器植骨融合治疗腰椎退行性疾病的效果。方法 检索PubMed、Cochrane Library、Embase、中国知网、万方、维普和中国生物医学文献数据库等中英文数据库，检索时间为从建库起至2020年11月1日，得到相关的文献后，阅读并提取关键数据，利用Review Manager 5.3软件分析数据。结果 最终纳入14篇文献（共计1 271例）。Meta分析结果提示：单纯植骨组与椎间融合器植骨组的手术时间[MD=-4.50，95%CI(-7.15，-1.85)，P=0.000 9]、术中出血量[MD=-12.98，95%CI(-20.72，-5.23)，P=0.001）]和手术费用[MD=-6 395.89，95%CI(-6 992.61，-5 799.18)，P<0.000 01]的差异有统计学意义；椎间融合器植骨组与单纯植骨组的术后椎间隙高度[MD=-1.46，95%CI(-1.60，-1.33)，P<0.000 01]的差异有统计学意义；术后JOA评分、术后腰椎前凸角和并发症发生率比较，差异无统计学意义（P=0.48、P=0.25和P=0.69）。结论 在椎间隙融合方式上，椎间融合器植骨能较好地维持术后椎间隙高度，其临床疗效优于单纯植骨。但椎间融合器植骨手术用时偏多，术中出血较多，手术费用较高。在临床椎间融合方式的具体选择中，建议遵循因人制宜的原则。

Clinical efficacy and safety of simple bone grafting fusion and interbody fusion cage bone grafting in the treatment of degenerative lumbar diseases:A Meta-analysis

[Abstract]Objective To compare the effects of simple bone graft fusion and intervertebral fusion cage bone grafting in the treatment of lumbar degenerative diseases through Meta-analysis. Methods The study searched PubMed, Cochrane Library, Embase, CNKI, Wanfang, VIP and China Biomedical Literature Database and other Chinese and English databases. The search time was from the establishment of the database to November 1, 2020. After obtaining the relevant literatures, key data were read,extracted,and analyzed using Review Manager 5.3 software. Results Fourteen articles were finally included (a total of 1 271 cases). Meta-analysis indicated that the operation time [MD=-4.50, 95%CI(-7.15, -1.85), P=0.000 9], intraoperative blood loss [MD=-12.98, 95%CI(-20.72,-5.23),P=0.001] and the surgical cost [MD=-6 395.89, 95%CI(-6 992.61, -5 799.18), P<0.000 01]of simple bone grafting fusion and intervertebral fusion cage bone grafting were statistically significant. The postoperative intervertebral space height of intervertebral fusion cage bone grafting and simple bone grafting fusion [MD=-1.46, 95%CI(-1.60,-1.33),P<0.000 01] was statistically significant. The postoperative JOA score,the postoperative lumbar lordosis angle and the incidence of complications were not statistically significant(P=0.48, P=0.25 and P=0.69). Conclusion In terms of intervertebral space fusion, intervertebral fusion cage bone grafting can better maintain the height of the intervertebral space after surgery, and its clinical efficacy are better than simple bone grafting fusion. However, the operation of bone grafting with intervertebral fusion cage bone grafting takes more time,has more bleeding during the operation, and costs higher. In the specific selection of clinical intervertebral fusion, it is recommended to follow the principle of adapting measures to individual conditions.