Li Yu-Zhe, Sun Piao, Chen Dong, Tang Li, Chen Chun-Hui, Wu Ai-Min
The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, The Second School of Medicine Wenzhou Medical University, Zhejiang Spine Surgery Center, Department of Spine Surgery, Wenzhou, China.
Turk Neurosurg. 2020;30(1):1-10. doi: 10.5137/1019-5149.JTN.24799-18.2.
To conduct an updated systematic review and meta-analysis to compare the efficacy and safety between total disc replacement (TDR) and fusion surgery for lumbar degenerative disc disease (LDDD).
We comprehensively searched meta-analyses comparing TDR with fusion through the PubMed, Embase, and Cochrane Library databases. Only randomized controlled trials (RCTs) were selected and collected. The end of the retrieval time was June 2017. Two authors independently extracted the data from the studies after assessing their quality. The statistical software STATA version 12.0 was used to analyze the data.
A total of seven RCTs (1706 patients) were included in our analysis. The patients in the TDR group had significantly improved. A greater percentage of these patients were satisfied with the surgery concerning Oswestry disability index, visual analog scale score, and complication rate. In addition, the clinical success in the TDR group was greater than that in the fusion group. Meanwhile, the TDR group had shorter operative time and hospital stay. However, there was no clinical significance regarding blood loss, work status, and reoperation rate between the two groups.
Our current updated meta-analysis suggests that TDR could be an alternative treatment for LDDD, since it yielded better clinical success and patient satisfaction, shorter hospital stay and operative time, less pain, and lower complication rates than lumbar fusion.
进行一项更新的系统评价和荟萃分析，以比较全椎间盘置换术（TDR）与融合手术治疗腰椎退行性椎间盘疾病（LDDD）的疗效和安全性。
我们通过PubMed、Embase和Cochrane图书馆数据库全面检索了比较TDR与融合手术的荟萃分析。仅选择并收集随机对照试验（RCT）。检索时间截止到2017年6月。两名作者在评估研究质量后独立从研究中提取数据。使用统计软件STATA 12.0对数据进行分析。
我们的分析共纳入7项RCT（1706例患者）。TDR组患者有显著改善。在奥斯威斯功能障碍指数、视觉模拟量表评分和并发症发生率方面，这些患者中对手术满意的比例更高。此外，TDR组的临床成功率高于融合组。同时，TDR组的手术时间和住院时间更短。然而，两组之间在失血量、工作状态和再次手术率方面无临床显著差异。
我们当前更新的荟萃分析表明，TDR可作为LDDD的一种替代治疗方法，因为与腰椎融合术相比，它具有更好的临床成功率和患者满意度、更短的住院时间和手术时间、更少的疼痛以及更低的并发症发生率。
