Lan Tao, Hu Shi-Yu, Zhang Yuan-Tao, Zheng Yu-Chen, Zhang Rui, Shen Zhe, Yang Xin-Jian
Department of Spine Surgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, P.R. China.
Department of Neurology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, P.R. China.
World Neurosurg. 2018 Apr;112:86-93. doi: 10.1016/j.wneu.2018.01.021. Epub 2018 Jan 31.
To compare the efficacy and safety in the management of lumbar diseases performed by either posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF). Interbody fusion is considered the "gold standard" in the treatment of lumbar degenerative diseases. Both PLIF and TLIF have been advocated, and it remains controversial as to the best operative technique.
The electronic databases including Embase, PubMed, and Cochrane library were searched to identify relevant studies up to September 2017. The primary outcomes were fusion rate, complications, and clinical satisfaction. The secondary outcomes were length of hospitalization, operation time, blood loss, postoperative visual analog scale, Oswestry Disability Index, and Japanese Orthopaedic Association Score. Data analysis was conducted with RevMan 5.3 software.
A total of 16 studies involving 1502 patients (805 patients in PLIF group and 697 in TLIF group) were included in the meta-analysis. The pooled analysis showed that there was no significant difference in terms of fusion rate (P > 0.05) and clinical satisfaction (P > 0.05) between the 2 groups. TLIF was superior to PLIF with significantly lower incidence of nerve root injury (P < 0.05) and dural tear (P < 0.05). However, there was no significant difference regarding wound infection (P > 0.05) and graft malposition (P > 0.05). PLIF required significant longer operation time (P < 0.05) and was associated with more blood loss (P < 0.05). Although TLIF was associated with better postoperative visual analog scale, Oswestry Disability Index, and Japanese Orthopaedic Association Score than PLIF, there was no statistical difference regarding these results.
The available evidence suggests that both TLIF and PLIF could achieve similar clinical satisfaction and fusion rate in the management of degenerative lumbar diseases. However, TLIF was superior to PLIF with shorter operation time, less blood loss, and lower incidence of nerve root injury and dural tear. There is no significant difference between both groups regarding wound infection and graft malposition.
比较后路腰椎椎间融合术（PLIF）与经椎间孔腰椎椎间融合术（TLIF）治疗腰椎疾病的疗效和安全性。椎间融合术被认为是治疗腰椎退行性疾病的“金标准”。PLIF和TLIF均被提倡，然而关于最佳手术技术仍存在争议。
检索包括Embase、PubMed和Cochrane图书馆在内的电子数据库，以识别截至2017年9月的相关研究。主要结局指标为融合率、并发症及临床满意度。次要结局指标为住院时间、手术时间、失血量、术后视觉模拟评分、Oswestry功能障碍指数及日本骨科协会评分。采用RevMan 5.3软件进行数据分析。
荟萃分析共纳入16项研究，涉及1502例患者（PLIF组805例，TLIF组697例）。汇总分析显示，两组间融合率（P>0.05）及临床满意度（P>0.05）无显著差异。TLIF在神经根损伤发生率（P<0.05）和硬脊膜撕裂发生率（P<0.05）方面优于PLIF，显著更低。然而，在伤口感染（P>0.05）和植骨位置不当（P>0.05）方面无显著差异。PLIF所需手术时间显著更长（P<0.05），且失血量更多（P<0.05）。尽管TLIF术后视觉模拟评分、Oswestry功能障碍指数及日本骨科协会评分优于PLIF，但这些结果无统计学差异。
现有证据表明，在退行性腰椎疾病的治疗中，TLIF和PLIF均可获得相似的临床满意度和融合率。然而，TLIF在手术时间、失血量、神经根损伤及硬脊膜撕裂发生率方面优于PLIF。两组在伤口感染和植骨位置不当方面无显著差异。
