Rothman Institute & Thomas Jefferson University Hospital, 925 Chestnut Street, Philadelphia, PA, 19107, USA.
Clin Orthop Relat Res. 2014 Jun;472(6):1792-9. doi: 10.1007/s11999-014-3619-5.
Although conventional open posterior lumbar interbody fusion (open PLIF) is efficacious in management of lumbar spinal instability, concerns exist regarding lengthy hospital stays, blood loss, and postoperative complications. Minimally invasive posterior lumbar interbody fusion (MIS PLIF) may be able to address these concerns, but the research on this topic has not been systematically reviewed.
QUESTIONS/PURPOSES: We performed a systematic review to determine whether MIS PLIF or open PLIF results in (1) better perioperative parameters, including blood loss, operative times, and length of hospital stay; (2) improved patient-reported outcome scores; and (3) improved disc distraction and (4) frequency of reoperation and complications when compared with open PLIF procedures.
A literature search of the MEDLINE database identified seven studies that met our inclusion criteria. A total of seven articles were included; quality was assessed using the Methodological Index for Non-Randomised Studies (MINORS) scale. Descriptive statistics were used to describe the included articles.
In most studies, MIS PLIF was associated with decreased blood loss and shorter hospital stay but longer operative times. MIS PLIF resulted in better patient-related outcomes when compared with open PLIF in two studies in the short term, but most of the studies in this review found no short-term differences, and there was no difference at long-term followup in any studies. There was no significant difference in disc distraction. Both techniques appeared to have similar complication rates and reoperation rates.
Based on the available evidence, which we restricted to prospective and retrospective studies with control groups, but did not include any well-designed randomized trials, MIS PLIF might lead to better perioperative parameters, but there was little evidence for improved patient-reported outcomes in the MIS groups. Randomized controlled trials are needed to compare these two surgical techniques.
虽然传统的开放式后路腰椎体间融合术（open PLIF）在治疗腰椎失稳方面是有效的，但存在住院时间长、失血多和术后并发症等问题。微创后路腰椎体间融合术（MIS PLIF）可能能够解决这些问题，但关于这一主题的研究尚未进行系统回顾。
问题/目的：我们进行了一项系统回顾，以确定 MIS PLIF 或 open PLIF 是否在以下方面具有优势：（1）更好的围手术期参数，包括失血、手术时间和住院时间；（2）改善患者报告的结果评分；（3）改善椎间盘撑开；（4）与 open PLIF 手术相比，再次手术和并发症的频率。
对 MEDLINE 数据库进行文献检索，确定了符合我们纳入标准的 7 项研究。共有 7 篇文章符合纳入标准；使用非随机研究方法学指数（MINORS）量表评估质量。使用描述性统计来描述纳入的文章。
在大多数研究中，MIS PLIF 与减少失血和缩短住院时间相关，但手术时间更长。与 open PLIF 相比，MIS PLIF 在两项短期研究中与更好的患者相关结果相关，但本综述中的大多数研究发现短期没有差异，在任何研究中，长期随访都没有差异。椎间盘撑开没有显著差异。两种技术似乎具有相似的并发症发生率和再次手术率。
根据现有的证据，我们将其限制在具有对照组的前瞻性和回顾性研究中，但不包括任何精心设计的随机试验，MIS PLIF 可能导致更好的围手术期参数，但在 MIS 组中，患者报告的结果改善证据很少。需要随机对照试验来比较这两种手术技术。
