经Quadrant通道微创TLIF术与传统开放TLIF术治疗腰椎退行性病变的Meta分析

Meta analysis of minimally invasive TLIF through Quadrant channel in the treatment of lumbar degenerative disease

目的比较Quadrant通道经椎间孔腰椎融合术(transforaminal lumbar interbody fusion,TLIF)和传统TLIF术治疗腰椎退行性疾病的临床效果,为Quadrant通道TLIF术的临床应用提供循证医学证据。方法手工检索骨科相关杂志,计算机系统检索中英文数据库,收集并纳入关于比较Quadrant通道TLIF术与传统TLIF术治疗椎间盘退行性变的相关随机对照临床研究。提取纳入文献中的数据并使用Rev Man 5.2软件进行Meta分析。结果纳入5篇文献共计患者326例,其中mini-TLIF组145例,open-TLIF组181例。mini-TLIF组比open-TLIF组术后出血量少、住院时间短、术后周围肌肉组织水肿消散早、术后早期缓解疼痛效果好。二者长期的功能评分无明显差异,但mini-TLIF组存在术中透视时间长,对医护人员、患者的X线暴露时间增加的缺点。结论 Quadrant通道TLIF术与传统TLIF术长期临床疗效及安全性比较,无明显差异。Quadrant通道TLIF术在出血量、住院时间、术后周围肌肉组织水肿消散、早期缓解疼痛方面有显著优越性。Quadrant通道TLIF的不足之处是术中透视时间长。

Objective To compare the clinical effect of minimally invasive transforaminal lumbar interbody fusion （TLIF） through Quadrant channel and conventional TLIF in the treatment of lumbar degenerative disease, aimed to provide evidence of evidence-based medicine for the clinical application of TLIF. Methods We searched journals of orthopedics by manual retrieval, and searched Chinese/English database by computer system. Randomize control studies comparing the effect of minimally invasive TLIF through Quadrant channel and conventional TLIF in the treatment of lumbar degenerative disease were collected in our study. RevMan 5.2 was used for meta analysis. Result Five studies involving a total of 326 cases were recruited. Among them, 145 cases were treated by Quadrant channel TLIF, and 181 cases were treated by normal TLIF. Compared with the traditional TLIF, Quadrant channel TLIF has less bleeding, shorter hospital stay, and postoperative peripheral muscle tissue edema. There was no significant difference in the functional scores of the two types of operation. However, the Quadrant channel TLIF had some disadvantages, such as longer fluoroscopy time, and longer X-ray exposure time. Conclusion The long-term clinical efficacy and safety of the two surgical procedures are similar. There are significant advantages in Quadrant channel TLIF in the amount of bleeding, hospitalization time, early pain relief and so on, but the fluoroscopy time during operation is too long.