短节段与长节段固定融合修复退变性脊柱侧凸的Meta分析

A meta-analysis of short fusion versus long fusion for degenerative scoliosis

背景:目前退变性脊柱侧凸治疗的主要目的是解除患者症状,手术矫正侧凸畸形恢复脊柱的平衡及功能,但目前修复方式的选择存在一定的争议。目的:系统评价短节段与长节段固定融合修复退变性脊柱侧凸的效果及安全性。方法:通过CNKI、CBM、VIP、万方数据库等中文数据库,Pubmed、EMbase、Cochrane library等外文数据库,收集2015年5月前国内外已公开发表的关于短节段与长节段固定融合修复退变性脊柱侧凸的试验。采用Rev Man 5.3.4软件对纳入文献进行统计分析。结果与结论:共计纳入11篇文献,共533例患者。其中短节段组272例,长节段261例。Meta分析结果显示:两种固定方法相比,脊柱Cobb角的改善(P<0.000 01)、脊柱前凸角的改善(P<0.000 01)方面,长节段组的疗效明显优于短节段组。冠状面失衡的矫正(P=0.06)、侧向滑脱矫正(P=0.24)方面两组差异无显著性意义。在日本骨科协会评分(P=0.93)、目测类比评分(P=0.22)以及Oswestry功能障碍指数(P=0.13)的改善方面,两组差异无显著性意义。在术后并发症(P=0.0006)以及术后再手术率方面(P=0.03),长节段组高于短节段组,两组在临近节段病变的发生率上差异无显著性意义(P=0.81)。提示长节段固定融合在纠正脊柱畸形方面优于短节段固定融合,但修复后并发症及再手术率高于短节段固定融合,在选择固定融合方案时应综合考虑。

BACKGROUND： At present, the main purpose of treatment for degenerative scoliosis is to relieve symptoms, surgically correct scoliosis, restore balance and function of the spine, but what kind of techniques is superior has been controversial.OBJECTIVE： To systematically assess the clinical effectiveness and safety of short fusion versus long fusion for degenerative scoliosis. METHODS： The databases such as China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Chinese Scientific Journals Database, Wan Fang Database, The Cochrane Library, Pub Med, and EMbase published before May 2015 were electronically searched to collect the trials about the short fusion versus long fusion for degenerative scoliosis. Meta-analysis was performed by using Rev Man 5.3.4 software. RESULTS AND CONCLUSION： Eleven studies were included, with 533 patients, including 272 cases in the short fusion group and 261 cases in the long fusion group. Meta-analysis results showed that： compare with short fusion group, long fusion group had better improvement of spine Cobb angle（P〈0.000 01） and lordosis angle（P〈0.000 01）. No differences were found in the coronal imbalance（P=0.06） and lateral slippage（P=0.24） between the two groups. No significant difference was detected in Japanese Orthopaedic Association score（P=0.93）, Visual analogue scale score（P=0.22）, and Oswestry Disability Index score（P=0.13） between the two groups. The postoperative complications（P=0.000 6） and the rate of reoperation（P=0.03） were higher in the long fusion group than those in the short fusion group. The incidence of adjacent segment disease has no difference between the two groups（P=0.81）. These findings suggest that long fusion is better than short fusion in improvement of the deformity of spine, but incidence of postoperative complications and the rate of reoperation are higher than those in the short fusion group. Comprehensive consideration should be given to the selection of a fixed fusion scheme.