减压融合经皮椎弓根螺钉与开放椎弓根螺钉内固定手术治疗腰椎滑脱的系统评价

Decompression and fusion combined with percutaneous pedicle screw internal fixation versus open pedicle screw internal fixation for treatment of lumbar spondylolisthesis: a systematic review

目的:评价减压融合经皮椎弓根螺钉与开放椎弓根螺钉内固定手术治疗腰椎滑脱的疗效和安全性。方法:应用计算机检索Pub Med、The Cochrane Library、Embase、中国知网、维普网建库至2018年5月10日收录的所有减压融合经皮椎弓根螺钉内固定手术(经皮组)和减压融合开放椎弓根螺钉内固定手术(开放组)治疗腰椎滑脱的随机对照研究文献。由2位研究者独立筛选文献、提取资料,依据Cochrane系统评价手册(5. 3版)进行文献方法学质量评价后,采用Rev Man5. 3软件进行Meta分析。结果:最初共检索到57篇文献,经筛选后最终纳入9篇文献,其中7篇为中文文献、2篇为英文文献。Meta分析结果显示,与开放组相比,经皮组的手术时间短[MD=-26. 16,95%CI(-42. 14,-10. 17)]、术中出血量少[MD=-176. 66,95%CI(-252. 92,-100. 39)]; 2组的融合率比较,差异无统计学意义[OR=2. 49,95%CI(0. 52,11. 86)]。8篇文献描述了并发症发生情况,各文献中2组的并发症均较少,但具体并发症不一致,无法进行合并分析。利用并发症发生率进行发表偏倚分析,漏斗图显示分布基本对称,不存在发表偏倚。结论:减压融合经皮椎弓根螺钉内固定手术和减压融合开放椎弓根螺钉内固定手术均是治疗腰椎滑脱的有效方法,均具有较高的安全性; 2种手术方法的融合率相当,但前者的手术时间短、术中出血量少。

Objective:To evaluate the curative effects and safety of combination therapy of decompression,fusion and percutaneous pedicle screw internal fixation versus combination therapy of decompression,fusion and open pedicle screw internal fixation for treatment of lumbar spondylolisthesis.Methods:All the randomized controlled trial(RCT)articles about combination therapy of decompression,fusion and percutaneous pedicle screw internal fixation(group A)versus combination therapy of decompression,fusion and open pedicle screw internal fixation(group B)for treatment of lumbar spondylolisthesis included from database establishing to May 10,2018 were retrieved from PubMed,The Cochrane Library,Embase,China national knowledge internet and VIP Database through computer.The articles were screened and the information was extracted independently by two searchers.The methodological quality of research in the articles was evaluated according to Cochrane systematic evaluation handbook 5.3 and a Meta-analysis was conducted by using RevMan 5.3 software.Results:Fifty-seven articles were searched out in the initial stage.After screening,9 articles(7 Chinese articles and 2 English articles)were included in the final analysis.The results of Meta-analysis demonstrated that the operative time was shorter and the intraoperative blood loss was less in group A compared to group B(MD=-26.16,95%CI(-42.14,-10.17);MD=-176.66,95%CI(-252.92,-100.39)).There was no statistical difference in fusion rate between the 2 groups(OR=2.49,95%CI(0.52,11.86)).The complications were described in 8 articles and they were less in both of the 2 groups.The 2 groups were inconsistent with each other in types of complications,so merged analysis could not be conducted.Publication bias was analyzed according to complication incidence,and the basically symmetrical funnel plot demonstrated that there was no publication bias.Conclusion:Both the combination therapy of decompression,fusion and percutaneous pedicle screw internal fixation and the combination therapy of decompression,fusion and open pedicle screw internal fixation are effective for treating lumbar spondylolisthesis,and both of them have high safety.Moreover,the two therapies are similar to each other in fusion rate,while the former has such advantages as shorter operation time and less intraoperative blood loss.