微创经椎间孔入路腰椎椎间融合术中单侧与双侧内固定治疗单节段腰椎退行性疾病的荟萃分析

目的 对微创经椎间孔入路腰椎椎间融合术（MIS-TLIF）中采用单侧与双侧椎弓根螺钉内固定治疗单节段腰椎退行性疾病的临床效果进行荟萃分析。方法 检索PubMed、Embase、Web of Science、中国知网、万方数据、维普网数据库中建库至2022年4月的关于MIS-TLIF中采用单、双侧内固定治疗腰椎退行性疾病的对照研究，提取纳入文献的研究数据，通过纽卡斯尔-渥太华量表（NOS）对纳入文献进行质量评价。采用Review Manager 5.4软件对数据进行荟萃分析。结果 共18篇文献纳入研究，受试者总计1 201例，其中单侧组568例、双侧组633例。2组腰痛视觉模拟量表（VAS）评分与Oswestry功能障碍指数（ODI）改善值、并发症发生率方面差异无统计学意义（P > 0.05）；单侧组术中出血量、手术时间明显少于双侧组，差异有统计学意义（P < 0.05）；2组末次随访融合率差异有统计学意义（P < 0.05）。结论 MIS-TLIF术中采用单侧与双侧内固定治疗单节段腰椎退行性疾病均能取得良好疗效，单侧内固定术中出血量更少、手术时间更短，但腰椎稳定性及术后融合率不及双侧内固定，且术后发生融合器移位和脊柱侧凸的风险更大。

Unilateral and bilateral internal fixation in minimally invasive transforaminal lumbar interbody fusion for single-level lumbar degenerative diseases: a meta-analysis

Objective To conduct a meta-analysis of the clinical effects of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) with unilateral and bilateral pedicle screw fixation in the treatment of single-level lumbar degenerative diseases. Methods PubMed, Embase, Web of Science, CNKI, Wanfang Data and VIP databases were searched for controlled studies of unilateral and bilateral internal fixation in MIS-TLIF for the treatment of lumbar degenerative diseases from the establishment of the database to April 2022. The data of the included literatures were extracted, and the quality of the included literatures were evaluated by the Newcastle-Ottawa scale(NOS). Review Manager 5.4 software was used for the meta-analysis. Results A total of 18 literatures were included in the study, with a total of 1 201 subjects, including 568 cases in unilateral group and 633 in the bilateral group. There was no significant difference in low back pain visual analogue scale(VAS) score improvement value, Oswestry disability index(ODI) improvement value, and complication rate between the 2 groups(P > 0.05). The intraoperative blood loss and operation time in the unilateral group were significantly less than those in the bilateral group(P < 0.05). There was significant difference in fusion rate between the 2 groups at the final follow-up(P < 0.05). Conclusions MIS-TLIF with unilateral or bilateral pedicle screw fixation in the treatment of single-level lumbar degenerative diseases all can achieve good clinical effects. Unilateral internal fixation has less intraoperative blood loss and operation time, but lumbar stability and postoperative fusion rate are lower than bilateral internal fixation, and the risk of postoperative cage displacement and scoliosis is greater.