斜外侧入路与后入路椎体融合术治疗腰椎退行性疾病临床疗效的Meta分析

目的系统性对比评价斜外侧入路椎间融合术(OLIF)与后入路椎体融合术(PLIF)在治疗腰椎退行性疾病中的临床疗效。方法在中国知网数据库、万方数据库、维普数据库以及PubMed数据库、Cochrane数据库,以“斜外侧椎间融合术”“后入路椎间融合术”和“oblique lumbar interbody fusion”“oblique lateral interbody fusion”“anterior to psoas”“posterior lumbar interbody fusion”为关键词,计算机检索2010年1月—2019年9月国内外已发表关于OLIF与PLIF对比的病例对照研究或随机对照研究的中英文文献,严格评价文献质量,并提取相关数据,运用RevMan 5.3软件对手术时间、术中出血量、住院时间、疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、椎间隙高度(IDH)、腰椎前凸角(LL),以及手术并发症情况进行Meta分析。结果纳入10篇研究共580例患者,其中经OLIF手术276例,经PLIF手术304例。1项随机对照研究,Cochrane偏倚风险评估为低风险;9项病例对照研究纽卡斯尔-渥太华评分(NOS),其中高质量6项、较高质量3项。Meta分析结果显示,OLIF较PLIF平均手术时间短(WMD=-84.02,95%CI-118.29^-49.74,P<0.01),平均术中出血量少(WMD=-269.12,95%CI-319.84^-218.41,P<0.01),平均住院时间短(WMD=-3.29,95%CI-4.70^-1.89,P<0.01),术后IDH恢复更高(WMD=1.11,95%CI 0.44~1.77,P<0.01),差异均有统计学意义;而术后ODI(WMD=0.16,95%CI-1.98~2.30,P>0.05)、VAS(WMD=0.02,95%CI-0.52~0.56,P>0.05)、LL(WMD=0.77,95%CI-0.40~1.94,P>0.05)、并发症发生情况(OR=0.91,95%CI 0.50~1.64,P>0.05),OLIF和PLIF比较差异均无统计学意义。结论OLIF与PLIF应用于椎体间融合术均能取得良好的临床疗效,但OLIF手术时间、术中出血量、住院时间更低,术后IDH恢复更高,有更大优势。

Clinical efficacy of oblique lateral interbody fusion and posterior lumbar interbody fusion for lumbar degenerative diseases:a Meta-analysis

Objective To compare the clinical efficacy of oblique lumbar interbody fusion(OLIF)and posterior lumbar interbody fusion(PLIF)in the treatment of lumbar degenerative diseases.Methods Reports were used case-control studies and randomized clinical trials to compare the oblique lumbar interbody fusion with posterior approach interbody fusion were retried from China National Knowledge Internet,Wanfang Data,Weipu Data,PubMed Library,and Cochrane Library,from January 2010 to September 2019.The searched key words were“斜外侧椎间融合术”“后入路椎间融合术”and“oblique lumbar interbody fusion”“oblique lateral interbody fusion”“anterior to psoas”“posterior lumbar interbody fusion”.Methodological quality of the trials was critically assessed.Statistical software Revman 5.3 was used for data analysis,and average operation time,average blood loss,average length of hospital stays,VAS,ODI,IDH,LL,and complications were analysis.Results A total of 580 patients from 10 articles were included,276 patients using OLIF and 304 patients using PLIF.One randomized controlled trial was low risk evaluated by Cochrane Collaboration risk of bias assessment tool,and six cases controlled trials were high quality and three cases controlled trials were middle high quality evaluated by the Newcastle-Ottawa scale risk of bias assessment tool.The results showed that,when the efficacy of OLIF and PLIF were compared,there was statistical significance in the average operation time(WMD=-84.02,95%CI-118.29 to-49.74,P<0.01),average blood loss(WMD=-269.12,95%CI-319.84 to-218.41,P<0.01),average length of hospital stays(WMD=-3.29,95%CI-4.70 to-1.89,P<0.01),IDH(WMD=1.11,95%CI 0.44 to 1.77,P<0.01).However,there was no statistical significance in ODI post operation(WMD=0.16,95%CI-1.98 to 2.30,P>0.05),VAS post operation(WMD=0.02,95%CI-0.52 to 0.56,P>0.05),LL(WMD=0.77,95%CI-0.40 to 1.94,P>0.05),complications(OR=0.91,95%CI 0.50 to 1.64,P>0.05).Conclusions Both approaches achieve similar and satisfactory clinical effect in the interbody fusion.However,OLIF has a greater advantage in terms of operation time,blood loss,length of hospital stays,IDH.