单纯减压与减压融合治疗退行性腰椎滑脱的Meta分析

Decompression alone versus decompression plus fusion for degenerative lumbar spondylolisthesis:a metaanalysis

目的系统评价比较单纯减压与减压融合术治疗退行性腰椎滑脱(degenerative lumbar spondylolisthesis,DLS)的临床疗效。方法计算机检索PubMed、Web of Science、The Cochrane library、Embase、中国生物医学文献服务系统、中国知网、万方数据库,检索时间从建库至2022年12月。提取纳入研究的基本信息、Oswestry功能障碍指数(oswestry disability index,ODI)、腰腿痛的疼痛数字评分(numeric rating scale,NRS)、欧洲五维健康量表(European quality of life-5 dimensions,EQ-5D)、临床优良率、并发症及再手术率等指标,采用RevMan 5.4.1软件进行Meta分析。结果共纳入随机对照研究5篇,队列研究19篇,共82787例患者(其中单纯减压组9678例,减压融合组73109例)。术后第1年,在ODI(P=0.0006,MD=2.40,95%CI:1.03~3.77),EQ-5D(P=0.01,MD=-0.05,95%CI:-0.10~-0.01),腰背痛NRS评分(P=0.008,MD=0.57,95%CI:0.15~1.00),腿痛NRS评分(P=0.0008,MD=0.53,95%CI:0.22~0.84)改善方面,两组差异有统计学意义,减压融合组优于单纯减压组。术后第2年,两组ODI、EQ-5D、腰背痛、腿痛NRS评分差异无统计学意义(分别为P=0.12,P=0.59,P=0.55,P=0.12)。两组再手术率差异无统计学意义(P=0.50,RR=1.08,95%CI:0.86~1.37),而单纯减压组并发症发生率(P<0.0001,RR=0.71,95%CI:0.59~0.84)低于减压融合组,且单纯减压组可缩短手术时间、住院时间,减少术中出血量。结论减压融合较单纯减压治疗DLS短期内有优势,但术后2年随访,两者临床疗效相当,且单纯减压组与更少的术后并发症,更短的手术时间、住院时间,更少的出血量相关。

Objective To compare the clinical outcomes of decompression alone and decompression with fusion for degenerative lumbar spondylolisthesis(DLS)by a meta-analysis.Methods We searched the databases of PubMed,Web of Science,The Cochrane library,Embase,SinoMed,CNKI and Wanfang Database for relevant literature from their inception to December 2022.The basic information of the included studies,Oswestry disability index(ODI),NRS(NRS)score of low back and leg pain,European quality of life-5 dimensions(EQ-5D),clinical satisfaction,complications and reoperation rate were extracted,and RevMan 5.4.1 was used for meta-analysis.Results A total of 5 randomized controlled studies and 19 cohort studies with a total of 82787 patients(including 9678 in the decompression alone group and 73109 in the decompression with fusion group)were included.At the first postoperative year,differences in ODI(P=0.0006,MD=2.40,95%CI:1.03-3.77),EQ-5D(P=0.01,MD=-0.05,95%CI:-0.10--0.01),low back pain score(P=0.008,MD=0.57,95%CI:0.15-1.00),leg pain score(P=0.0008,MD=0.53,95%CI:0.22-0.84)were statistically significant between the two groups;and results of the decompression with fusion group were better than the decompression alone group.In the second year after surgery,there were no significant differences in ODI,EQ-5D,low back pain and leg pain between the two groups(P=0.12,P=0.59,P=0.55,P=0.12,respectively).There was no significant difference in the reoperation rate between the two groups(P=0.50,RR=1.08,95%CI:0.86-1.37),while the complication rate(P<0.0001,RR=0.71,95%CI:0.59-0.84)in the decompression alone group was lower than that in the decompression with fusion group,and the decompression alone could shorten the operation time,hospital stay and reduce the amount of blood loss.Conclusions The decompression with fusion group shows advantages over the decompression alone group in treating DLS in the short term,but there is no significant difference in clinical efficacy between the two groups at 2 years follow-up after surgery.Decompression alone group has fewer postoperative complications,shorter operation time,hospital stay,and less blood loss.