Zhang Chang-Meng, Li Hao-Yun, Li Shu-Shan, Zhu Zhi, Yang Kai, Sun Tian-Sheng
The First Department of Orthopaedics, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou 450007, Henan, China;
Zhongguo Gu Shang. 2018 Jun 25;31(6):569-576. doi: 10.3969/j.issn.1003-0034.2018.06.017.
Meta analysis was used to evaluate the efficacy and safety of Dynesys and posterior decompression and fusion internal fixation for lumbar degenerative diseases.
The computer was used to retrieve the Cochrane library, Medline, Embase, CNKI, Wanfang database and Chinese biomedical literature database; and the references and main Chinese and English Department of orthopedics journals were manually searched. All the prospective or retrospective comparative studies on the clinical efficacy and safety of Dynesys and posterior decompression and fusion internal fixation were collected, so as to evaluate the methodological quality of the study and to extract the data. The RevMan 5.2 software provided by Cochrane collaboration was used for systematic evaluation.
A total of 9 clinical studies were included, including 3 prospective randomized controlled trials(RCT) and 6 retrospective controlled observational studies, which included 692 patients, with 336 cases in Dynesys group, and 356 cases in posterior decompression and fusion internal fixation (PLIF) group. The results showed that compared with PLIF, Dynesys system significantly decreased operation time(<0.01), intraoperative blood loss (<0.01). Both Dynesys and PLIF groups experienced improved ODI and back/leg pain VAS scores at final follow-up, and no statistically significant difference was noted according to the two surgical procedures(>0.05). Dynesys could remain the range of motion (ROM) of surgical segments with less increased ROM of adjacent segments compared with that of PLIF group(<0.01). Regarding the disc height of surgical segments, no statistically significant difference was noted according to the two groups(>0.05), but postoperative complications incidence rate in PLIF group was higher than that in Dynesys group (<0.05).
Both Dynesys system and PLIF can improve clinical outcomes of lumbar degenerative diseases effectively. Compared with PLIF, Dynesys could remain the range of motion(ROM) of surgical segments with less increased ROM of adjacent segments and lower complication incidence rate. But the ability to prevent adjacent segments degeneration needs more RCTs with long-term follow-up to confirm.
采用Meta分析评价Dynesys系统与后路减压融合内固定术治疗腰椎退变性疾病的疗效和安全性。
应用计算机检索Cochrane图书馆、Medline、Embase、中国知网、万方数据库及中国生物医学文献数据库；同时手工检索参考文献及主要中英文骨科杂志。收集所有关于Dynesys系统与后路减压融合内固定术临床疗效及安全性的前瞻性或回顾性对照研究，评价研究的方法学质量并提取数据。采用Cochrane协作网提供的RevMan 5.2软件进行系统评价。
共纳入9项临床研究，其中前瞻性随机对照试验（RCT）3项，回顾性对照观察性研究6项，共692例患者，Dynesys组336例，后路减压融合内固定术（PLIF）组356例。结果显示，与PLIF相比，Dynesys系统显著缩短手术时间（<0.01）、减少术中出血量（<0.01）。末次随访时Dynesys组和PLIF组的ODI及腰/腿痛VAS评分均改善，两种手术方式比较差异无统计学意义（>0.05）。与PLIF组相比，Dynesys系统可保留手术节段的活动度（ROM），相邻节段ROM增加较少（<0.01）。手术节段椎间盘高度两组比较差异无统计学意义（>0.05），但PLIF组术后并发症发生率高于Dynesys组（<0.05）。
Dynesys系统和PLIF均能有效改善腰椎退变性疾病临床疗效。与PLIF相比，Dynesys系统可保留手术节段的活动度，相邻节段ROM增加较少，并发症发生率较低。但预防相邻节段退变的能力尚需更多长期随访的RCT证实。
