长节段与短节段固定融合治疗成人退行性脊柱侧弯meta分析

摘要

Objective To evaluate the surgical outcome and clinical value between long fusion and short fusion in treatment of adult degenerative scoliosis disease. Methods The Medline database,Embase database,Web of Science,Cochrane library,Ovid,Chinese Biomedical database, CNKI database and VIP database were searched for controlled trials,prospective cohort study and retrospective cohort study on the comparison between long fusion and short fusion in treatment of adult degenerative scoliosis disease. Furthermore,Revman 5.1 software was used for Meta-analy-sis. Results Four studies involving 288 cases were included (167 cases in short fusion group,121 cases in long fusion group).Meta-analysis indicated that,Cobb angle change (p=0.03),Coronal change(P=0.0002),ODI(P=0.005)of long fusion group is superior to that of short fusion group,but Operation time (P=0.04) of long fusion group is longer than short fusion group,and there was no statistical significant difference in Lateral listhesis change between two groups(P=0.22). Conclusion The current evidence shows long fusion is superior to short fusion,but long fusion surgical proce-dure is considered a long time,more bleeding,complication rates and surgical risk is relatively large,we need to conduct a comprehensive assessment of the patient before surgery. More RCTs are required to verify these conclusions owing to the limitations of the present study.%目的：综合评价长节段固定融合与短节段固定融合两种手术方式在治疗成人退行性脊柱侧弯的术后疗效。方法检索1983～2013年间Medline、Embase、Web of Science、Cochrane library、Ovid、中国生物医学文献数据库系统（CBM）、中国期刊全文数据库（CNKI）、中文科技期刊全文数据库（VIP）数据库所有关于两种术式比较的临床研究，用RevMan 5.1统计软件进行Meta分析。结果纳入研究的文献共4篇，合计病例288例（短节段组167例，长节段组121例）。Meta分析显示，手术前后cobb角改善程度（P=0.03）、冠状偏移改善程度（P=0.0002）、术后ODI指数（P=0.005）长节段组均优于短节段组，而手术时间（P=0.04）长节段组要长于短节段组，腰椎侧向滑移改善程度比较二者比较未发现显著差异（P=0.22）。结论现有的证据表明长节段固定融合治疗成人退行性脊柱侧弯有更佳的治疗效果，但手术时间长，出血较多，患者术后并发症发生率及手术风险相对较大，术前需要对患者进行全面的评估后选择手术方案。受本文纳入研究文献的数量和质量限制。上述结论尚需更多高质量的随机对照研究论证。