经椎间孔和后路腰椎椎体间融合术治疗腰椎滑脱及腰椎不稳临床疗效的Meta分析

Meta-analysis of clinical effects of transforaminal lumbar interbody fusion versus posterior lumbar interbody fusion on lumbar spondylolisthesis and lumbar instability in Chinese population

目的系统评价后路腰椎椎体间融合术（PLIF）和经椎间孔腰椎椎体间融合术（TLIF）在治疗国人腰椎滑脱和腰椎不稳的临床疗效。方法检索中国学术文献总库（CNKI）、中国生物医学文献数据库（CMBdisc）、万方数据知识服务平台及相关中文骨科期刊关于PLIF和TLIF两种手术方式治疗腰椎滑脱及腰椎不稳的临床对照研究。将符合条件的研究结果用StataSE11．2软件进行Meta分析，分析指标包括手术时间、术中出血量、手术并发症、术后椎间隙高度、融合率、疼痛视觉模拟评分（VAs）、Oswestry功能障碍指数（ODD及日本骨科学会下腰痛评分（JOA）改善率。结果共12项研究符合纳入标准，累计病例1041例，其中PLIF组520例，TLIF组521例。手术时间，PLIF组长于TLIF组，标准化均数差（SMD）-1．26，95％CI：o．58-1．94，P〈0．001；术中出血量，PLIF组多于TLIF组（SMD=1．70，95％CI：0．94-2．46，P〈0．001）；手术并发症，PLIF组多于TLIF组，（OR-4．50，95％CI：2．65-7．64，P％0．001）。以下4项分析指标两组差异无统计学意义：术后椎间隙高度，SMD=-0．07，95％CI：-0．44-0．30，P-0．730；术后VAS，SMD--0．07，95％CI：-0．27-0．13，P-0．515；术后0DI，SMD=0．15，95％CI：-0．06-0．35，P：0．155；术后JOA优良率，OR-1．43，95％CI：0．75-2．73，P-0．280；术后融合率，OR=1．17，95％CI：0．63-2．15，P-0．616。结论TLIF手术在缩短手术时间、减少术中出血量、降低手术并发症发生率方面相对PLIF有明显优势，两种手术在恢复并维持椎间隙高度、临床疗效方面可取得相同效果。

Objective To evaluate the clinical effects of transforaminal lumbar interbody fusion （TLIF） versus posterior lumbar interbody fusion （PLIF） on lumbar spondylolisthesis and lumbar instability in Chinese patients. Methods Literatures about clinical effects of TLIF and PLIT on lumbar spondylolisthesis and lumbar instability were collected from Chinese academic literature database （CNKI）, Chinese biomedical literature database （CMBdisc）, Wanfang database and Chinese journals of orthopedics. Data from those literatures including operation time, bleeding volume, surgical complications, postoperative interspace height, visual analog scale （VA$） score, Oswestry Disability Index （ODD and improvement rate of Japanese Orthopedic Association （JOA） score were analyzed by Stata $E 11.2 software. Results A total of 12 literatures met the inclusion criteria and 1041 cases were included （PLIF group, n=- 520; PLIF group, n= 521）. The operation time was longer in PLIF group than in TLIF group [standardized mean difference （SMD）= 1.26, 95%CI.. 0.58-1.94, P〈0. 001]. The bleeding volume was more in PLIF group than in TLIF group SMD= 1.70, 95%CI O. 94-2.46, P〈0. 001）. The surgical complications were more in PLIF group than in TLIF group （SMD=4.50, 95CI.. 2.65-7.64, P〈0. 001）. There were no statistical differences in postoperative interspace height, VAS score, ODI score, improvement rate of JOA score and fusionrate between the two groups SMD=--0.07, --0.07, 0.15, 1.43, 95%CI--0.44-0.30, --0.27- 0.13, --0.06-0.35, 0.75-2.73, 0.63 2. 15, respectively, all P〈0. 051. Conclusions TLIF has significant advantages on decreasing operation time, bleeding volume and risk of surgical complications as compared with PLIF. TLIF and PLIF have the same clinical efficacy on restoring and maintaining postoperative interspace height.