Jin-Tao Qu, Yu Tang, Mei Wang, Xu-Dong Tang, Tian-Jian Zhang, Guo-Hua Shi, Lei Chen, Yue Hu, Zi-Tian Wang, Yue Zhou
Department of Orthopedics, NO.44 hospital, 64# Huanghe RD, Guiyang, 550009, Guizhou, China.
Eur Spine J. 2015 May;24(5):1058-65. doi: 10.1007/s00586-015-3890-5. Epub 2015 Mar 28.
Meta-analysis was conducted to estimate whether MiTLIF could reduce the complication rate while maintaining the similar clinical result to that of open procedures.
A search of the literature was conducted on pubmed or EMBASE. A database including patient clinical information was created. A systematic review of eligible studies with multivariate regression analysis was performed to quantitatively review the correlation of VAS improvement rate and the performance of MiTLIF.
Fourteen articles with a minimum of 12-month follow-up met our inclusion criteria. The hypothesis of homogeneity could be accepted. The fixed-effects model was used to calculate the summary risk ratio (odds ratio). In the pooled analysis, the summary risk ratio (odds ratio) in patients with MiTLIF against those with open procedure for fusion rate, complication rate and revision/readmission rate was 0.99 (p = 0.36), 1.15 (p = 0.5) and 2.59 (p = 0.003), respectively, suggesting that MiTLIF was a risk factor for revision/readmission. Multivariate regression analysis showed that the percentage of male patients and the length of surgery exert a significant impact on VAS improvement rate. The selection of MiTLF was not significant.
Fusion rate and complication rate for both open and MiTLIF were similar. Moreover, the MiTLIF group tended to have a higher revision/readmission rate, which might be associated with the deep learning curve. Therefore, to achieve the level of surgical skill required of an MiTLIF surgeon, many years of training and experience are necessary. Otherwise, MiTLIF may yield unsatisfactory result upon patients.
进行荟萃分析以评估微创经椎间孔腰椎椎间融合术（MiTLIF）在保持与开放手术相似临床效果的同时是否能降低并发症发生率。
在PubMed或EMBASE上进行文献检索。创建了一个包含患者临床信息的数据库。对符合条件的研究进行系统评价并结合多因素回归分析，以定量评估视觉模拟评分（VAS）改善率与MiTLIF手术效果之间的相关性。
14篇随访时间至少为12个月的文章符合我们的纳入标准。齐性假设可以接受。采用固定效应模型计算汇总风险比（优势比）。在汇总分析中，MiTLIF组与开放手术组在融合率、并发症发生率和翻修/再入院率方面的汇总风险比（优势比）分别为0.99（p = 0.36）、1.15（p = 0.5）和2.59（p = 0.003），表明MiTLIF是翻修/再入院的一个危险因素。多因素回归分析显示男性患者比例和手术时长对VAS改善率有显著影响。MiTLF的选择无显著影响。
开放手术和MiTLIF手术的融合率和并发症发生率相似。此外，MiTLIF组的翻修/再入院率往往较高，这可能与学习曲线较深有关。因此，要达到MiTLIF手术医生所需的手术技能水平，需要多年的培训和经验。否则，MiTLIF手术可能给患者带来不尽人意的结果。
