PLF 与 PLIF 治疗峡部裂腰椎滑脱效果的 Meta 分析

摘要

目的：系统性评价后外侧融合（internal fixation and posterolateral fusion，PLF）与后路椎间融合（posterior lum-bar interbody fusion，PLIF）治疗短节段峡部裂型腰椎滑脱的临床效果。方法计算机检索 Medline、PubMed、Cochrane Library、Ovid、SpringerLink、中国生物医学文献数据库、万方、维普等数据库，并手工检索相关杂志搜集关于 PLF 和 PLIF的随机对照试验。按纳入和排除标准对检索到的文献进行筛选，采用 RevMan 5.1软件对结局指标进行 Meta 分析。结果纳入5篇随机对照试验（randomized controlled trials，RCT）文献，共409例患者，PLF 组206例，PLIF 组203例。Meta分析结果显示，与PLIF组相比，PLF组的平均手术时间较少（ MD =-29.71，95% CI：-42.85~-16.57，P ﹤0.00001），融合率较低（OR =0.41，95% CI：0.22~0.76，P =0.005），但两组术式在平均失血量（MD =172.35，95% CI：-78.03~422.729，P =0.18）、并发症（OR =1.62，95% CI：0.59~4.51，P =0.35）、再次手术率（OR =3.03，95% CI：0.46~20.00，P =0.25）及临床结果优良率（OR =0.59，95% CI：0.30~1.15，P =0.12）方面差异无统计学意义。结论与PLIF 治疗短节段峡部裂型腰椎滑脱相比，PLF 的手术时间较短，融合率较低，其余方面未见差异。但本Meta 分析的某些比较存在明显异质性，同时也存在多种偏倚的可能，所以此结果仍需要长期随访的高质量的随机对照试验进一步证实此结论。%Objective To systematically compare and evaluate internal fixation and posterior lumbar interbody fusion (PLIF)and internal fixation and posterolateral fusion(PLF)in short-level lumbar spondylolisthesis. Methods The references from inception to September 2013 concerning PLIF and PLF for the short-level lumbar spondylolisthesis were retrieved through Medline,PubMed,Cochrane Library,Ovid,SpringerLink,the China Biological Medicine Database,Wafang Database and Weipu Database,as well as by manually searching the related journals and grey literature. The eligible trials were extracted according to the inclusion and exclusion criteria. The included trials were evaluated the methodological quality. RevMan5. 1 software was used for data analysis. Results The Five RCTs were included in the final meta-analysis,enrolling a total of 203 PLF cases and 206 PLIF cases. The results of meta-analysis showed that statistically difference between PLF and PLIF in the mean operation time(MD = - 29. 71,95% CI:- 42. 85 ~ - 16. 57,P ﹤ 0. 00001)andfusionrate(OR = 0. 41,95% CI:0. 22 ~ 0. 76,P =0. 005). There were no statistically difference in mean blood loss(MD = 172. 35,95% CI:- 78. 03 ~ 422. 729,P = 0. 18), complicationrate(OR = 1. 62,95% CI:0. 59 ~ 4. 51,P = 0. 35),reoperationrate(OR = 3. 03,95% CI:0. 46 ~ 20. 00,P =0. 25)and excellent and good rate of clinical outcomes(OR = 0. 59,95% CI:0. 30 ~ 1. 15,P = 0. 12). Conclusion The meta-analysis shows that the PLF has less mean operation time than PLIF and PLIF has higher fusion rate than PLF. However,this meta-analysis has several main limitations,so high-quality randomized controlled trials with long-term follow-up are needed to further assess these outcomes.