Dynesys与后路减压融合内固定术治疗腰椎退行性疾病临床疗效的系统评价

目的:通过Meta分析评价Dynesys与后路减压融合内固定术治疗腰椎退行性疾病的有效性与安全性。方法:计算机检索Cochrane图书馆、Medline、Embase、CNKI、万方数据库和中国生物医学文献数据库,手工检索相关文献的参考文献及主要中英文骨科杂志。收集所有比较Dynesys和后路减压融合内固定术临床疗效与安全性的中、英文前瞻性或回顾性对照研究,评价纳入研究的方法学质量并提取资料,采用Cochrane协作网提供的Rev Man 5.2软件进行系统评价。结果:共纳入9项临床研究,其中3个前瞻性随机对照研究,6个回顾性对照观察研究。共692例患者,其中Dynesys组336例,后路减压融合内固定术组356例。Meta分析结果显示:与后路减压融合内固定术相比,Dynesys显著缩短了手术时间(P0.01)、减少了术中出血量(P0.01);与术前相比,在末次随访时二者均显著改善了患者ODI评分及腰腿痛VAS评分,差异无统计学意义(P0.05);Dynesys有效保留了固定节段部分活动度,但后路减压融合内固定术组患者邻近节段活动度的增加大于Dynesys组(P0.01);二者对于固定节段椎间高度的改善差异无统计学意义(P0.05),但后路减压融合内固定术具有较高的术后并发症发生率(P0.05)。结论:Dynesys和后路减压融合内固定术均是治疗腰椎退行性疾病的有效方式。与后路减压融合内固定术相比,Dynesys可以保留固定节段部分活动度,邻近节段活动度增幅及术后并发症发生率均较低,但其对于邻近节段退变的预防需要更多长期随访的前瞻性临床随机对照试验加以验证。

Dynesys and posterior decompression and fusion internal fixation for the treatment of lumbar degenerative diseases: a systematic review

Objective: Meta analysis was used to evaluate the efficacy and safety of Dynesys and posterior decompression and fusion internal fixation for lumbar degenerative diseases.Methods: The computer was used to retrieve the Cochrane library,Medline,Embase,CNKI,Wanfang database and Chinese biomedical literature database; and the references and main Chinese and English Department of orthopedics journals were manually searched. All the prospective or retrospective comparative studies on the clinical efficacy and safety of Dynesys and posterior decompression and fusion internal fixation were collected,so as to evaluate the methodological quality of the study and to extract the data. The RevMan 5.2 software provided by Cochrane collaboration was used for systematic evaluation.Results: A total of 9 clinical studies were included,including 3 prospective randomized controlled trials(RCT) and 6 retrospective controlled observational studies,which included 692 patients,with 336 cases in Dynesys group,and 356 cases in posterior decompression and fusion internal fixation (PLIF) group. The results showed that compared with PLIF,Dynesys system significantly decreased operation time(P<0.01),intraoperative blood loss (P<0.01). Both Dynesys and PLIF groups experienced improved ODI and back/leg pain VAS scores at final follow-up,and no statistically significant difference was noted according to the two surgical procedures(P>0.05). Dynesys could remain the range of motion (ROM) of surgical segments with less increased ROM of adjacent segments compared with that of PLIF group(P<0.01). Regarding the disc height of surgical segments,no statistically significant difference was noted according to the two groups(P>0.05),but postoperative complications incidence rate in PLIF group was higher than that in Dynesys group (P<0.05).Conclusion: Both Dynesys system and PLIF can improve clinical outcomes of lumbar degenerative diseases effectively. Compared with PLIF,Dynesys could remain the range of motion(ROM) of surgical segments with less increased ROM of adjacent segments and lower complication incidence rate. But the ability to prevent adjacent segments degeneration needs more RCTs with long-term follow-up to confirm.