Liang Hai-Feng, Liu Shu-Hao, Chen Zi-Xian, Fei Qin-Ming
Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
Eur Spine J. 2017 Dec;26(12):3084-3095. doi: 10.1007/s00586-017-5200-x. Epub 2017 Jun 24.
To compare the clinical effectiveness of decompression plus fusion and decompression alone for patients with degenerative lumbar spondylolisthesis, a systematic review and meta-analysis of all available evidence was performed.
A search of the literature was conducted on PubMed/MEDLINE, EMBASE, and the Cochrane Collaboration Library. Relevant studies comparing decompression plus fusion and decompression alone were selected according to eligibility criteria. Predefined endpoints were extracted and meta-analyzed from the identified studies.
Four randomized controlled trials and 13 observational studies were eligible. The pooled data revealed that fusion was associated with significantly higher rates of satisfaction and lower leg pain scores when compared with decompression alone. However, fusion significantly increased the intraoperative blood loss, operative time and hospital stay. Both techniques had similar ODI, back pain scores, complication rate, and reoperation rate.
Based on the available evidence, decompression plus fusion maybe be better than decompression alone in the treatment of degenerative spondylolisthesis. Fusion had advantages of improvement of clinical satisfaction, as well as reduction of postoperative leg pain, with similar complication rate to decompression alone.
为比较减压加融合术与单纯减压术治疗退变性腰椎滑脱症患者的临床疗效，对所有可用证据进行了系统评价和荟萃分析。
在PubMed/MEDLINE、EMBASE和Cochrane协作图书馆进行文献检索。根据纳入标准选择比较减压加融合术与单纯减压术的相关研究。从纳入研究中提取预定义的终点指标并进行荟萃分析。
4项随机对照试验和13项观察性研究符合要求。汇总数据显示，与单纯减压术相比，融合术的满意度更高，小腿疼痛评分更低。然而，融合术显著增加了术中失血量、手术时间和住院时间。两种技术在功能障碍指数（ODI）、背痛评分、并发症发生率和再次手术率方面相似。
基于现有证据，减压加融合术在治疗退变性腰椎滑脱症方面可能优于单纯减压术。融合术具有提高临床满意度以及减轻术后小腿疼痛的优点，并发症发生率与单纯减压术相似。
