短节段融合与长节段融合治疗伴有平衡型退变性腰椎侧凸的腰椎管狭窄症：直接比较研究的荟萃分析。
Short Limited Fusion Versus Long Fusion With Deformity Correction for Spinal Stenosis With Balanced De Novo Degenerative Lumbar Scoliosis: A Meta-analysis of Direct Comparative Studies.
机构信息
Department of Neurosurgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
出版信息
Spine (Phila Pa 1976). 2017 Oct 1;42(19):E1126-E1132. doi: 10.1097/BRS.0000000000002306.
STUDY DESIGN
A systematic review and meta-analysis.
OBJECTIVE
The aim of this study was to identify advantages and disadvantages of long versus short fusion for patients with Spinal stenosis with Balanced de novo degenerative lumbar Scoliosis without substantial Sagittal imbalance (SBSS), and to determine whether short fusions and long fusions have different curve progression after surgeries and differences in operative characteristics.
SUMMARY OF BACKGROUND DATA
Patients with SBSS usually undergo short limited fusion or long fusion with curve correction. There is debate regarding whether short fusion is insufficient for SBSS for prevention scoliosis progression.
METHODS
A systematic search of PubMed, Embase, Web of Science, and the Cochrane Library was performed to find studies assessing the comparison of surgical techniques for SBSS. We included all direct comparative studies comparing short and long fusion and extracted data about scoliosis progression, changes in the Oswestry Disability Index (ODI), perioperative outcomes, and complication rates. A meta-analysis was performed to calculate weighted mean differences (WMDs) and 95% confidence intervals (CIs).
RESULTS
We included data from six studies involving 362 patients (short fusion, 202 patients; long fusion, 160 patients). Both the short fusion and the long fusion groups showed decreased Cobb angle (short, 22.38°-11.69°; long, 30.74°-12.77°) and C7 plumb at the final follow-up. The long fusion group showed a substantial decrease in Cobb angle (WMD, 8.94; 95% CI, 2.55-15.33) and in C7 plumb (WMD, 5.90; 95% CI, -0.39-12.18), compared to the short fusion group. At final follow-up, ODI had decreased similarly in both groups (WMD, 1.70; 95% CI, -13.04-9.65). The short fusion group showed advantages including decreased blood loss (mean difference, 739.9 mL) and shorter operative time (mean difference, 68.0 minutes) compared to the long fusion group.
CONCLUSION
Short fusion may be a reasonable option for patients with SBSS and at low risk for curve progression.
LEVEL OF EVIDENCE
研究设计
系统回顾和荟萃分析。
目的
本研究旨在确定对于伴有新发性退变性腰椎侧凸且矢状面平衡无明显改变的腰椎管狭窄症（SBSS）患者，长节段与短节段融合的优缺点，并确定短节段融合和长节段融合在术后的曲线进展以及手术特点方面是否存在差异。
背景资料概要
SBSS 患者通常接受短节段有限融合或长节段融合加曲线矫正。对于 SBSS 患者，短节段融合是否不足以预防脊柱侧凸进展存在争议。
方法
对 PubMed、Embase、Web of Science 和 Cochrane 图书馆进行系统检索，以查找评估 SBSS 手术技术比较的研究。我们纳入了所有比较短节段融合和长节段融合的直接比较研究，并提取了有关脊柱侧凸进展、Oswestry 功能障碍指数（ODI）变化、围手术期结果和并发症发生率的数据。进行荟萃分析以计算加权均数差（WMD）和 95%置信区间（CI）。
结果
我们纳入了 6 项研究的数据，共涉及 362 例患者（短节段融合 202 例，长节段融合 160 例）。短节段融合组和长节段融合组的 Cobb 角均显著减小（短节段融合组，22.38°-11.69°；长节段融合组，30.74°-12.77°），C7 铅垂线在末次随访时也显著减小。与短节段融合组相比，长节段融合组的 Cobb 角（WMD，8.94；95%CI，2.55-15.33）和 C7 铅垂线（WMD，5.90；95%CI，-0.39-12.18）显著减小。末次随访时，两组 ODI 均显著下降（WMD，1.70；95%CI，-13.04-9.65）。与长节段融合组相比，短节段融合组具有以下优势：术中出血量减少（平均差值，739.9 ml）和手术时间缩短（平均差值，68.0 分钟）。
结论
对于 SBSS 且脊柱侧凸进展风险较低的患者，短节段融合可能是一种合理的选择。
证据水平
1 级。
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