开放与微创经椎间孔椎体间融合治疗单节段退行性腰椎疾病的Meta分析★

摘要

背景：微创经椎间孔椎体间融合技术采用微小切口经可扩张通道进行，与开放经椎间孔椎体间融合技术相比，微创技术视野小，操作更为精细，对周围组织的损伤较小，有利于恢复。　　目的：对微创经椎间孔椎体间融合技术与开放经椎间孔椎体间融合技术治疗单节段退行性腰椎疾病的疗效及临床价值进行评价。　　方法：检索2005至2012年间 Cochrane library、PubMed、Embase、SCI、中国生物医学文献数据库、中国知网和万方数据库，手工检索相关文献的参考文献及4种中文主要骨科杂志，纳入以单节段退行性腰椎疾病为研究对象，比较微创与开放经椎间孔椎体间融合技术治疗的随机对照试验，前瞻性队列研究及回顾性队列研究，严格评价纳入研究的方法学质量并提取资料，用 Cochrane 协作网提供的Revman5.1进行 Meta 分析。　　结果与结论：经过筛选纳入7个研究(856例患者)。7个研究圴选用手术时间作为观察指标，结果显示微创手术的手术操作时间与开放手术比较差异无显著性意义(P=0.11)；6个研究选用术中出血量作为观察指标，结果显示微创手术的术中出血量明显少于开放手术(P <0.00001)；2个研究选用手术后下地时间作为观察指标，结果显示微创手术的术后下地时间短于开放手术(P <0.00001)；6个研究选用术中及术后早期并发症作为观察指标，结果显示微创手术的并发症与开放手术比较差异无显著性意义(P=0.75)；3个研究选用融合率作为观察指标，结果显示微创手术的术后融合率与开放手术比较差异无显著性意义(P=1.00)。提示微创经椎间孔椎体间融合技术是治疗单节段退行性腰椎疾病较理想的方式。%BACKGROUND: Minimal y invasive transforaminal lumbar interbody fusion can be performed through a tiny incision using a expandable channel. Compared with open transforaminal lumbar interbody fusion, minimal y invasive transforaminal lumbar interbody fusion has smal er surgical field, more elaborate operation and less injury to the surrounding tissue which is conductive to accelerate overal recovery. OBJECTIVE: To evaluate the surgical outcome and clinicaI value between minimal y invasive and open transforaminal lumbar interbody fusion in treatment of single segment degenerative lumbar disease. METHODS: The Cochrane library, PubMed database, Embase database, SCI database, CNKI database, Wanfang database and Chinese Biomedical database were searched for control ed trials, prospective cohort study and retrospective cohort study on the comparison between minimal y invasive and open transforaminal lumbar interbody fusion in treatment of degenerative lumbar disease. Furthermore, we also manual y searched the relevant references and four Chinese orthopedic journals. Methodology quality of the trials was critical y assessed and the relative data were extracted. Cochrane Col aboration provided Revman 5.1 software was used for Meta-analysis. RESULTS AND CONCLUSION: Seven studies involving 856 cases were included. Al the studies observed the surgical time, and the results of Meta-analysis showed that there was no statistical y significant difference in the surgical time between minimal y invasive and open transforaminal lumbar interbody fusion (P=0.11); six studies observed the intraoperative blood loss, and the results showed that the intraoperative blood loss of minimal y invasive transforaminal lumbar interbody fusion was significantly less than that of the open transforaminal lumbar interbody fusion (P < 0.000 01); two studies observed the weight bearing time, and the results showed that the weight bearing time after minimal y invasive transforaminal lumbar interbody fusion was shorter than that after open transforaminal lumbar interbody fusion (P < 0.000 01); six studies observed the intraoperative and postoperative complications, and the results showed that there were no significant differences between minimal y invasive and open transforaminal lumbar interbody fusion (P=0.75); three studies observed the fusion rate, and the results showed there was no significant difference between minimal y invasive and open transforaminal lumbar interbody fusion (P=1.00). The results showed that minimal y invasive transforaminal lumbar interbody fusion was the ideal method for the treatment of single segment degenerative lumbar disease.