成人腰椎滑脱症的最佳融合技术是什么——经椎间孔腰椎椎体间融合术（PLIF）还是后路腰椎椎间融合术（PLF），或者是PLIF联合PLF？一项来自17项对比研究的荟萃分析。
What is the optimum fusion technique for adult spondylolisthesis-PLIF or PLF or PLIF plus PLF? A meta-analysis from 17 comparative studies.
作者信息
Liu Xiao-Yang, Qiu Gui-Xing, Weng Xi-Sheng, Yu Bin, Wang Yi-Peng
机构信息
*Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China; and †Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
出版信息
Spine (Phila Pa 1976). 2014 Oct 15;39(22):1887-98. doi: 10.1097/BRS.0000000000000549.
STUDY DESIGN
A meta-analysis and systemic review.
OBJECTIVE
To pool scientific evidence for the optimum selection in the treatment of lumbar spondylolisthesis by comparing the clinical effect of posterolateral fusion (PLF), posterior lumbar interbody fusion (PLIF), and PLIF plus PLF.
SUMMARY OF BACKGROUND DATA
Clinical effect of the 3 fusion techniques has been reported in many studies. However, which is the best method is in dispute.
METHODS
A systematic search was conducted in MEDLINE, EMBASE, and the Cochrane Collaboration Library from January 1950 through May 2013. Comparative studies were performed according to eligibility criteria. Weighted mean differences and risk differences were calculated for common outcomes. The final strength of evidence was expressed as different level recommended by the Grading of Recommendations Assessment, Development, and Evaluation Working Group.
RESULTS
Four randomized controlled trials and 13 observational studies were eligible. PLIF was more effective than PLF in the improvement of clinical satisfaction (odds ratio [OR], 0.52; 95% confidence interval (CI), 0.31-0.89; P=0.02). No significant differences in the primary outcomes were seen between PLIF plus PLF and PLF (OR, 0.88; 95% CI, 0.47-1.64; P=0.69). For the complication rate, the differences were not significant between PLIF and PLF, and between PLIF plus PLF and PLF (OR, 2.27; 95% CI, 0.95-5.42; P=0.07; OR, 0.74; 95% CI, 0.22-2.44; P=0.62, respectively). In the secondary outcomes, PLIF was more effective than PLF in the improvement of fusion rate (P=0.0007) and reoperation rate (P=0.004). However, PLIF plus PLF failed to reveal more superiority than PLF (P>0.05).
CONCLUSION
PLIF plus PLF did not show more superiority than PLF alone. PLIF alone improved clinical satisfaction and decreased complication rate compared with PLF. PLIF maybe be better than the other 2 fusion methods in the treatment of lumbar spondylolisthesis. However, conclusions need to be treated with caution because of lack of high quality of evidence.
LEVEL OF EVIDENCE
研究设计
一项荟萃分析和系统评价。
目的
通过比较后外侧融合术（PLF）、腰椎后路椎间融合术（PLIF）以及PLIF联合PLF的临床效果，汇总有关腰椎滑脱症治疗最佳选择的科学证据。
背景数据总结
许多研究报告了这三种融合技术的临床效果。然而，哪种方法最佳仍存在争议。
方法
于1950年1月至2013年5月在MEDLINE、EMBASE和Cochrane协作图书馆进行系统检索。根据纳入标准开展比较研究。计算常见结局的加权平均差和风险差。最终证据强度按照推荐分级评估、制定与评价工作组推荐的不同级别表示。
结果
四项随机对照试验和十三项观察性研究符合要求。在提高临床满意度方面，PLIF比PLF更有效（优势比[OR]，0.52；95%置信区间[CI]，0.31 - 0.89；P = 0.02）。PLIF联合PLF与PLF在主要结局方面未见显著差异（OR，0.88；95% CI，0.47 - 1.64；P = 0.69）。在并发症发生率方面，PLIF与PLF之间、PLIF联合PLF与PLF之间差异均无统计学意义（OR分别为2.27；95% CI，0.95 - 5.42；P = 0.07；OR，0.74；95% CI，0.22 - 2.44；P = 0.62）。在次要结局方面，PLIF在提高融合率（P = 0.0007）和再手术率（P = 0.004）方面比PLF更有效。然而，PLIF联合PLF未显示出比PLF更具优势（P > 0.05）。
结论
PLIF联合PLF并未显示出比单独使用PLF更具优势。与PLF相比，单独使用PLIF可提高临床满意度并降低并发症发生率。在腰椎滑脱症的治疗中，PLIF可能优于其他两种融合方法。然而，由于缺乏高质量证据，结论需谨慎对待。
证据级别
1级
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