单纯减压与减压融合术治疗老年退行性腰椎管狭窄症的Meta分析

Decompression versus decompression with fusion for treatment of degenerative lumbar spinal stenosis:a meta-analysis

目的对单纯减压术与减压融合术治疗老年退行性腰椎管狭窄症进行Meta分析。方法计算机检索Pub Med、Embase、Cochrane图书馆、万方数据库和中国期刊全文数据库中2016年2月以前的相关文献。根据纳入与排除标准,由2名研究者分别独立筛选文献,按照Cochrane偏倚风险评估工具严格进行质量评估,并利用Rev Man 5.2软件对相关结局指标(总体疗效、手术时间、术中出血量、并发症发生率、二次手术率)进行Meta分析。结果纳入9篇符合纳入标准的随机对照试验,共964例,单纯减压组580例,减压融合组384例。Meta分析结果显示,与减压融合组比较,单纯减压组手术时间和术中出血量明显更少,差异有统计学意义(P<0.05);而2组在术后总体疗效、并发症发生率和二次手术率方面差异无统计学意义(P>0.05)。结论单纯减压和减压融合术治疗老年退行性腰椎管狭窄症的疗效相当,但单纯减压术具有手术创伤小、出血量少、手术时间短、术后康复快的优点。

Objective To compare the clinical results between decompression alone and decompression with fusion for degenerative lumbar spinal stenosis. Methods A systematic search for relevant literatures was performed in PubMed, Embase, the Cochrane Library, CNKI and Wanfang Database up to Feb. 2016. According to inclusion and exclusion criteria, two researchers independently completed literature selection and data collection, the methodological quality assessments was conducted in accordance with the Cochrane collaboration＇s handbook. The recta-analysis was performed using the RevMan 5.2 software. Results A total of 964 patients from nine RCTs were subjected to recta-analysis （580 patients for decompression group, 384 patients for decompression with fusion）. The results of meta-analysis showed that the operation time and blood loss were significantly lower in decompression group than those in decompression with fusion group （P 〈0.05）. However, there were no statistically significant differences between two groups in regard to clinical effects, the rates of complications and secondary surgery（P 〉0.05）. Conclusion For the degenerative lumbar spinal stenosis, decompression appears to provide similar clinical effects compared with decompression and fusion, and no significant difference in the rates of complications and secondary surgery is noted. But the decompression can obviously decrease blood loss and operation time in comparison with the decompression and fusion.