经椎间孔椎体间融合术与经后路椎体间融合术治疗轻、中度退变性腰椎滑脱症临床疗效及安全性的Meta分析

A Meta-analysis: clinical efficacy and safety of TLIF versus PLIF for the treatment of mild-moderate degenerative lumbar spondylolisthesis

目的 :应用Meta分析综合评价经椎间孔椎体间融合术(transforaminal lumbar interbody fusion,TLIF)与经后路椎体间融合术(posterior lumbar interbody fusion,PLIF)治疗退变性腰椎滑脱症的临床疗效和安全性,为临床决策提供参考依据。方法:计算机检索中国期刊全文数据库(China national knowledge infrastructure,CNKI)、中国生物医学文献数据库(China biology medicine,CBM)、万方数据库(Wanfang Database)、Pub Med、The Cochrane Library、Elsevier Science Direct(SDOS)数据库中关于TLIF与PLIF治疗退变性腰椎滑脱症的文献,检索时限均是从各数据库建库时间至2017年8月。纳入文献包含以下参考指标中的两项以上:手术时间、术中出血量、融合例数、视觉模拟评分(visual analogue scale,VAS)、Oswestry功能残障指数(Oswestry disability index,ODI)、手术并发症例数、末次随访椎间高度、再手术例数。使用Cochrane Library提供的Rev Man 5.3软件进行Meta分析。结果:共纳入2篇随机对照研究,8篇队列研究。共纳入患者757例,其中TLIF组386例,PLIF组371例。两组在手术时间、术中出血量、并发症例数方面,TLIF组均少于PLIF组,差异有统计学差异(P<0.05)。两组在VAS评分、ODI评分、融合例数、恢复椎间高度、再手术例数方面,差异无统计学意义(P>0.05)。结论:两种椎间融合方式在术后VAS评分、ODI评分、融合例数、恢复椎间高度方面无显著性差异,临床疗效相当。TLIF在手术时间、术中出血量、总体并发症例数方面均少于PLIF,其安全性较高。

Objectives： Comprehensive evaluation of the clinical efficacy and safety of transforaminal lumbar interbody fusion（TLIF） and posterior lumbar interbody fusion with pedide（PLIF） screw fixation for the treatment of degenerative lumbar spondylollsthesis（DLS）, to provide evidence for clinical procedure. Methods： Databases including CNKI, CBM, Wanfang Database, PubMed, the Cochrane Library, Elsevier ScienceDireet（SDOS） were searched for studies of TLIF versus PL1F for degenerative lumbar spondylolisthesis from the inception respec- tively to August 2017. Included studies contain at least the following indicators： operation time, intraoperafive blood loss, fusions, visual analogue score（VAS）, Oswestry disability index（ODI）, complications, disc space height, reoperations. Review Manager 5.3 software was used for data analysis. Results： Two randomized con- trolled trials （RCT） and eight cohort studies including 757 patients were included in the meta-analysis： 386 patients in TLIF group, 371 patients in PLIF group. The results of meta-analysis showed that there were sta- tistical differences in operation time（P〈0.05）, intraoperative blood loss（P〈O.05） and complications（P〈O.05） be- tween two groups. There were no statistical differences in VAS（P=O.18）, ODI（P=0.27）, fusions（P=0.80）, disc space height（P=0.97） and reoperations（P=0.29）. Conclusion： Two cliff＇s,rent nlethods have no statistical dil]k,r- ence in VAS, ODI, fusions, disc space height. They have similar clinical efficacy. And, TLIF Mve less opera- tion time, intraoperative blood loss, and complications than PLII＂, TLIF satyr than PLIF.