Luo Jiaquan, Cao Kai, Yu Ting, Li Liangping, Huang Sheng, Gong Ming, Cao Cong, Zou Xuenong
*Department of Spine Surgery/Orthopaedic Research Institute, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou †Department of Orthopaedics, The First Affiliated Hospital of Nanchang University, Nanchang, P.R. China.
Clin Spine Surg. 2017 Aug;30(7):E915-E922. doi: 10.1097/BSD.0000000000000297.
Systematic review and meta-analysis.
Posterolateral fusion (PLF) and posterior lumbar interbody fusion (PLIF) were widely used in the treatment of lumbar isthmic spondylolisthesis (IS). There was a great controversy over the preferred fusion method.
The purpose of this study is to evaluate the clinical outcomes between PLF and PLIF for the treatment of IS.
Related studies that compared the clinical effectiveness of PLIF and PLF for the treatment of IS were acquired by a comprehensive search in 4 electronic databases (PubMed, EMBASE, Cochrane Controlled Trial Register, and MEDLINE) from January 1950 through December 2014. Included studies were performed according to eligibility criteria. The main endpoints included: improvement of clinical satisfaction, complication rate, reoperation rate, fusion rate, and reoperation rate.
A total of 9 studies were included in the meta-analysis; 6 were low-quality evidence and 2 were high-quality evidence as indicated by the Jadad scale. Compared with PLIF, PLF patients showed lower fusion rates [P=0.005, odds ratio (OR)=0.29 (0.14, 0.58)] and shorter operation times [P<0.00001, weighted mean difference (WMD)=-0.5(-0.61, -0.39)]. No significant difference was found in the term of postoperative visual analogue scale leg score [P=0.92, WMD=0.02 (-0.39, 0.44)] and visual analogue scale back score [P=0.41, WMD=0.20 (-0.28, 0.68)], blood loss [P=0.39, WMD=121.17 (-152.68, 395.01)], complication rate [P=0.42, OR=1.50 (0.56, 4.03)], postoperative Oswestry Disability Index [P=0.3, WMD=1.09 (-0.97, 3.15)], and postoperative clinical satisfaction [P=0.84, OR=1.06 (0.60, 1.86)].
In conclusion, our meta-analysis suggested that PLF shows significant lower fusion rate compared with PLIF. Although PLIF had more operation time than PLF, there was no significant difference in global assessment of clinical outcome between the 2 fusion procedures. However, future well-designed, randomized-controlled trials are still needed to further confirm our results.
系统评价与荟萃分析。
后外侧融合术（PLF）和腰椎后路椎间融合术（PLIF）广泛应用于腰椎峡部裂性脊椎滑脱症（IS）的治疗。对于哪种融合方法更优存在很大争议。
本研究旨在评估PLF和PLIF治疗IS的临床疗效。
通过全面检索4个电子数据库（PubMed、EMBASE、Cochrane对照试验注册库和MEDLINE），获取1950年1月至2014年12月间比较PLIF和PLF治疗IS临床疗效的相关研究。纳入的研究根据纳入标准进行。主要终点包括：临床满意度改善情况、并发症发生率、再次手术率、融合率和再次手术率。
荟萃分析共纳入9项研究；根据Jadad量表，6项为低质量证据，2项为高质量证据。与PLIF相比，PLF患者的融合率较低[P = 0.005，优势比（OR）= 0.29（0.14，0.58）]，手术时间较短[P < 0.00001，加权均数差（WMD）= -0.5（-0.61，-0.39）]。术后视觉模拟量表腿痛评分[P = 0.92，WMD = 0.02（-0.39，0.44）]、视觉模拟量表背痛评分[P = 0.41，WMD = 0.20（-0.28，0.68）]、失血量[P = 0.39，WMD = 121.17（-152.68，395.01）]、并发症发生率[P = 0.42，OR = 1.50（0.56，4.03）]、术后Oswestry功能障碍指数[P = 0.3，WMD = 1.09（-0.97，3.15）]和术后临床满意度[P = 0.84，OR = 1.06（0.60，1.86）]方面未发现显著差异。
总之，我们的荟萃分析表明，与PLIF相比，PLF的融合率显著较低。虽然PLIF的手术时间比PLF长，但两种融合手术在临床结局的总体评估上没有显著差异。然而，仍需要未来设计良好的随机对照试验来进一步证实我们的结果。
