MIS-TLIF与PLIF治疗单节段腰椎滑脱症有效性与安全性的Meta分析

A meta-analysis of the effectiveness and safety of MIS-TLIF and PLIF in the treatment of single-level lumbar spondylolisthesis

目的通过Meta分析评价微创经椎间孔腰椎椎间融合术(minimally invasive surgery transforaminal lumbar interbody fusion,MIS-TLIF)与后路腰椎椎间融合术(posterior lumbar interbody fusion,PLIF)治疗单节段腰椎滑脱症的有效性与安全性。方法检索PubMed、Embase、Web of Science、万方数据库、中国期刊全文数据库自建库至2021年11月有关MIS-TLIF与PLIF治疗单节段腰椎滑脱症中有效性及安全性的临床对照研究,筛选符合纳入标准的文献,使用数据提取表收集相关数据,采用Revman 5.4软件行Meta分析。结果本次Meta分析共纳入11项研究,涉及890例,其中MIS-TLIF组420例,PLIF组470例。Meta分析示,MIS-TLIF组与PLIF组在治疗单节段腰椎滑脱症术后总体并发症、椎间融合情况、手术时长方面差异均无统计学意义(P>0.05);与PLIF组相比,MIS-TLIF组在术中出血量(MD=-126.19,95%CI:-161.67~-90.72,P<0.01)、疼痛视觉模拟评分(visual analogue scale,VAS)(MD=-0.37,95%CI:-0.44~-0.29,P<0.01)、Oswestry功能障碍指数(oswestry disability index,ODI)(MD=-0.73,95%CI:-1.05~-0.42,P<0.01)及住院时长(MD=-3.03,95%CI:-3.31~-2.74,P<0.01)方面明显优于PLIF组,差异均有统计学意义。结论与PLIF相比,MIS-TLIF治疗单节段腰椎滑脱症可显著降低患者术中出血量、住院时长、术后VAS评分及ODI,但两种术式在改善术后总体并发症、椎间融合情况及缩短手术时长方面无明显差异。

Objective To evaluate the efficacy and safety of minimally invasive surgery transforaminal lumbar interbody fusion(MIS-TLIF)and posterior lumbar interbody fusion(PLIF)in single-level lumbar spondylolisthesis.Methods An extensive literature search was conducted in the databases of PubMed,Embase,Web of Science,Wanfang and CNKI.Studies comparing the efficacy and safety of MIS-TLIF and PLIF in the treatment of single-level lumbar spondylolisthesis were collected.The retrieval period is from the beginning of database building to November 2021.The data were analyzed by Revman 5.4 software.Results A total of 11 studies involving 890 patients were included in this Meta-analysis,of which 420 were in the MIS-TLIF group and 470 were in the PLIF group.Meta-analysis showed that there were no significant differences between the MIS-TLIF group and PLIF group in postoperative complication,intervertebral fusion,and operation time(P>0.05);However,the intraoperative bleeding volume(MD=-126.19,95%CI:-161.67--90.72,P<0.01),VAS score(MD=-0.37,95%CI:-0.44--0.29,P<0.01),ODI(MD=-0.73,95%CI:-1.05--0.42,P<0.01)and length of hospital stay(MD=-3.03,95%CI:-3.31--2.74,P<0.01)of the MIS-TLIF group were significantly better than those of the PLIF group.Conclusions Compared with the PLIF,the MIS-TLIF can significantly reduce the intraoperative blood loss,length of hospital stay,postoperative VAS and ODI in the treatment of single-level lumbar spondylolisthesis.However,there are no significant differences in postoperative complication,intervertebral fusion and operation time between the two surgical methods.