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对于腰椎退行性疾病，单侧椎弓根螺钉固定是否优于双侧椎弓根螺钉固定：一项荟萃分析。

Is unilateral pedicle screw fixation superior than bilateral pedicle screw fixation for lumbar degenerative diseases: a meta-analysis.

作者信息

Lu Pei, Pan Ting, Dai Teng, Chen Gang, Shi Ke-Qin

机构信息

Orthopedics Department, The Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, No. 68 Zhongshan Road, Wuxi, Jiangsu Province, 214000, China.

出版信息

J Orthop Surg Res. 2018 Nov 22;13(1):296. doi: 10.1186/s13018-018-1004-x.

DOI:10.1186/s13018-018-1004-x
PMID:30466462
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6249771/
Abstract

BACKGROUND: To investigate whether unilateral pedicle screw fixation is superior than bilateral pedicle screw fixation for lumbar degenerative diseases. METHODS: Electronic databases including PubMed, Embase, and the Cochrane Library up to August 2018 were searched. All the high-quality randomized controlled trials (RCTs) and prospective clinical controlled studies comparing the unilateral pedicle screw fixation and bilateral pedicle screw fixation for lumbar degenerative diseases were enrolled in this study. Fusion rate was the main outcome. Stata 12.0 was used for the meta-analysis. RESULTS: Twelve RCTs including 808 patients (unilateral pedicle screw fixation = 393, bilateral pedicle screw fixation = 415) were included in our meta-analysis. There was a significant difference between unilateral pedicle screw fixation and bilateral pedicle screw fixation in terms of the fusion rate (risk ratio (RR) = 0.96, 95%CI [0.92, 1.00], P = 0.073), visual analog scale (VAS) at final follow-up, Oswestry Disability Index (ODI), Japanese Orthopedic Association scores (JOA), short-form health survey (SF-36), and length of hospital stay. Compared with bilateral pedicle screw fixation, unilateral pedicle screw fixation was associated with a reduction of the total blood loss and operation time (P < 0.05). Unilateral pedicle screw fixation was associated with an increase of the cage migration than bilateral pedicle screw fixation (17.1% vs 7.1%, RR = 2.40, 95% CI = 1.17 to 4.93; P = 0.017). CONCLUSIONS: Unilateral pedicle screw fixation and bilateral pedicle screw fixation has similar fusion rate when treating for lumbar degenerative diseases. Our meta-analysis suggested that compared with bilateral pedicle screw fixation, unilateral pedicle screw fixation significantly reduced total blood loss and operation time for lumbar degenerative diseases. The use of unilateral pedicle screw for lumbar degenerative diseases increases the cage migration.

摘要

背景：探讨在腰椎退行性疾病治疗中，单侧椎弓根螺钉固定是否优于双侧椎弓根螺钉固定。 方法：检索截至2018年8月的电子数据库，包括PubMed、Embase和Cochrane图书馆。纳入所有比较单侧椎弓根螺钉固定与双侧椎弓根螺钉固定治疗腰椎退行性疾病的高质量随机对照试验（RCT）和前瞻性临床对照研究。融合率为主要结局指标。采用Stata 12.0进行荟萃分析。 结果：我们的荟萃分析纳入了12项RCT，共808例患者（单侧椎弓根螺钉固定组 = 393例，双侧椎弓根螺钉固定组 = 415例）。单侧椎弓根螺钉固定与双侧椎弓根螺钉固定在融合率（风险比（RR）= 0.96，95%CI [0.92, 1.00]，P = 0.073）、末次随访时的视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）、日本骨科协会评分（JOA）、简短健康调查（SF - 36）以及住院时间方面存在显著差异。与双侧椎弓根螺钉固定相比，单侧椎弓根螺钉固定可减少总失血量和手术时间（P < 0.05）。单侧椎弓根螺钉固定与双侧椎弓根螺钉固定相比，椎间融合器移位增加（17.1%对7.1%，RR = 2.40，95%CI = 1.17至4.93；P = 0.017）。 结论：在治疗腰椎退行性疾病时，单侧椎弓根螺钉固定与双侧椎弓根螺钉固定具有相似的融合率。我们的荟萃分析表明，与双侧椎弓根螺钉固定相比，单侧椎弓根螺钉固定可显著减少腰椎退行性疾病的总失血量和手术时间。在腰椎退行性疾病中使用单侧椎弓根螺钉会增加椎间融合器移位。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/977f/6249771/c2c48686e4be/13018_2018_1004_Fig15_HTML.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/977f/6249771/6cab10050617/13018_2018_1004_Fig7_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/977f/6249771/f8895b4a6d18/13018_2018_1004_Fig8_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/977f/6249771/805c5738fb0f/13018_2018_1004_Fig9_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/977f/6249771/43677974f626/13018_2018_1004_Fig10_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/977f/6249771/602b89efbf05/13018_2018_1004_Fig11_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/977f/6249771/7b58a2350fa3/13018_2018_1004_Fig12_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/977f/6249771/5ba3003d0d36/13018_2018_1004_Fig13_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/977f/6249771/642c436f5378/13018_2018_1004_Fig14_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/977f/6249771/c2c48686e4be/13018_2018_1004_Fig15_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/977f/6249771/09f2b1c43e01/13018_2018_1004_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/977f/6249771/ec9474647088/13018_2018_1004_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/977f/6249771/51860c449ff0/13018_2018_1004_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/977f/6249771/4d1bc7a0f814/13018_2018_1004_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/977f/6249771/1f4b83f74f94/13018_2018_1004_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/977f/6249771/0058cfb3a79e/13018_2018_1004_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/977f/6249771/6cab10050617/13018_2018_1004_Fig7_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/977f/6249771/f8895b4a6d18/13018_2018_1004_Fig8_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/977f/6249771/805c5738fb0f/13018_2018_1004_Fig9_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/977f/6249771/43677974f626/13018_2018_1004_Fig10_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/977f/6249771/602b89efbf05/13018_2018_1004_Fig11_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/977f/6249771/7b58a2350fa3/13018_2018_1004_Fig12_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/977f/6249771/5ba3003d0d36/13018_2018_1004_Fig13_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/977f/6249771/642c436f5378/13018_2018_1004_Fig14_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/977f/6249771/c2c48686e4be/13018_2018_1004_Fig15_HTML.jpg

相似文献

[1]
Is unilateral pedicle screw fixation superior than bilateral pedicle screw fixation for lumbar degenerative diseases: a meta-analysis.

J Orthop Surg Res. 2018-11-22

[2]
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[3]
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[4]
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[5]
[Unilateral versus bilateral pedicle screw fixation in minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF): a Meta analysis].

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[6]
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[7]
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[10]
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引用本文的文献

[1]
Clinical efficacy and quality of life in elderly patients with lumbar degenerative disease treated with TLIF combined with unilateral pedicle screw fixation: a randomized controlled study.

J Orthop Surg Res. 2025-4-26

[2]
Unilateral versus bilateral pedicle screw fixation in minimally invasive transforaminal lumbar interbody fusion: a systematic review and meta-analysis of randomized controlled trials.

Arch Orthop Trauma Surg. 2025-2-1

[3]
The comparison study of laminectomy with unilateral and bilateral pedicle screws fixation and laminectomy alone without fusion interbody in young patients with lumbar spinal stenosis: A randomized clinical trial.

Heliyon. 2024-7-30

[4]
Unilateral versus bilateral pedicle screw fixation with anterior lumbar interbody fusion: a comparison of postoperative outcomes.

Eur Spine J. 2024-9

[5]
Comparative Biomechanical Analysis of Unilateral, Bilateral, and Lateral Pedicle Screw Implantation in Oblique Lumbar Interbody Fusion: A Finite Element Study.

Bioengineering (Basel). 2023-10-24

[6]
Treatment of Lumbar Degenerative Disease with a Novel Interlaminar Screw Elastic Spacer Technique: A Finite Element Analysis.

Bioengineering (Basel). 2023-10-16

[7]
Far lateral lumbar interbody fusion with unilateral pedicle screw fixation and double traversing cages using a biportal endoscopic technique.

Acta Neurochir (Wien). 2023-8

[8]
Biomechanical analysis of Instrumented decompression and Interbody fusion procedures in Lumbar spine: a finite element analysis study.

Med Biol Eng Comput. 2023-7

[9]
Hybrid surgery of percutaneous transforaminal endoscopic surgery (PTES) combined with OLIF and anterolateral screws rod fixation for treatment of multi-level lumbar degenerative diseases with intervertebral instability.

J Orthop Surg Res. 2023-2-17

[10]
Percutaneous transforaminal endoscopic surgery combined with mini-incision OLIF and anterolateral screws rod fixation vs. MIS-TLIF for surgical treatment of single-level lumbar spondylolisthesis.

Front Surg. 2023-1-6

本文引用的文献

[1]
The effects of bisphosphonates on osteoporotic patients after lumbar fusion: a meta-analysis.

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Comparison of unilateral versus bilateral pedicle screw fixation with cage fusion in degenerative lumbar diseases: a meta-analysis.

Eur Spine J. 2015-4

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Lumbar fusion versus nonoperative management for treatment of discogenic low back pain: a systematic review and meta-analysis of randomized controlled trials.

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