腰椎后外侧融合与360°融合的系统评价

Meta-analysis of lumbar posterolateral fusion versus circumferential fusion in the treatment of the lumbar disease

目的对腰椎后外侧融合与360°融合治疗腰椎疾病的疗效进行系统对比评价。方法计算机检索MEDLINE（1966．1-2007．12，Ovid检索平台）、EMBASE（1984．1—2007．12）、Cochrance Central Register of Controlled Trial（4th Quarter 2007）、中国生物医学文献数据库（1986．1-2007．12）等，手工检索Spine、European Spine Journal、The Journal of Bone and Joint Surgery、《中华外科杂志》、《中华骨科杂志》、《中国脊髓脊柱杂志》等相关期刊，检索两种融合术式的相关病例研究结果、综述等相关内容，并评价纳入研究的方法学质量，采用RevMan 5．0．5．0软件对总体疗效、融合率、二次手术率、并发症发生率、平均手术时间、手术出血量进行荟萃分析。结果有4个临床随机对照试验（RCT）符合纳入标准，共437例患者。在融合率[OR 0．47，95％ CI（0．24，0．94）]、并发症发生率[OR 0．53，95％ CI（0．32，0．87）]、术中出血量[加权均数差值（WMD）=-349．95，95％ CI（-561．64，-138．26）]方面，360°融合组要高于后外侧融合组，差异具有统计学意义（P=0．030、0．010、0．001）；在二次手术率[OR 2．28，95％ CI（1．30，3．98）]方面，后外侧融合组要高于360°融合组，差异具有统计学意义（P=0．004）；在总体疗效[OR 1．04，95％ CI（0．64，1．68）]和手术时间[WMD=-90．24，95％ CI（-190．20，9．71）]上，两组差异无统计学意义（P=0．870、0．080）。结论360°融合组相比于后外侧融合组，能显著提高融合率，降低二次手术率，但并发症、术中出血量也显著高于后者。本研奔结果尚需萼多中心大样本RCT讲一步证实。

Objective To evaluate the efficacy of lumbar posterolateral fusion versus circumferential fusion in the treatment of the lumbar disease. Methods Searched MEDLINE （January, 1966 to December, 2007）, EMBASE （January, 1984 to December, 2007 ）, Coehranee Central Register of Controlled Trial （4th Quarter 2007） , The China Biological Medicine Database （1984 to December, 2007）, and hand searched several related journals, such as Spine, European Spine Journal, The Journal of Bone and Joint Surgery, Chinese Journal of Surgery, Chinese Journal of Orthopaedics, Chinese Journal of Spine and Spinal Cord, and so on. Searched the reviews, the clinical results and some other related studies on the two fusion techniques, and the quality of included trials was evaluated. Data were extracted by two reviewers independently with a designed extraction form. RevMan 5.0. 5.0 software was used for data analysis of the fusion rate, the complication rate, the re-operation rate, the operative blood loss, the clinical outcome, and the operation time. Results Four randomized clinical trials （RCTs） involving 437 patients were included. The results of Meta-analysis indicated that in the fusion rate [ OR 0. 47, 95% CI （ 0. 24, 0. 94 ）, P = 0. 030 ] , the complication rate [ OR 0. 53, 95% CI（ 0. 32, 0. 87 ）, P = 0. 010 ], and the operative blood loss [ weighted mean difference （WMD） = - 349. 95, 95% CI（ - 561.64, - 138.26 ）, P = 0. 001 ], the circumferential fusion group was significantly higher than the posterolateral fusion group. And in the re-operation rate [ OR 2. 28,95% CI（ 1.30, 3.98）, P = 0. 0041 the posterolateral fusion group was significantly higher than the circumferential fusion group. There were no statistically significant differences in the clinical outcome [ OR 1.04, 95% CI（0. 64, 1.68）, P = 0. 870 ] and the operation time [ WMD = - 90. 24, 95% CI （ - 190. 20, 9. 71 ）, P = 0. 080 ]. Conclusions To compare with the posterolateral fusion, the circumferential fusion can increase the fusion rate and reduce the re-operation rate, but it can also increase the complication rate and the blood loss. More high quality large-scale randomized controlled trials are required.