Bai Deng-Yan, Liang Long, Zhang Bing-Bing, Zhu Tao, Zhang Hai-Jun, Yuan Zhi-Guo, Chen Yan-Fei
Department of Orthopedics, Second Provincial People's Hospital of GanSu, Lanzhou, Gansu Province.
Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China.
Medicine (Baltimore). 2019 Jul;98(29):e16460. doi: 10.1097/MD.0000000000016460.
Lumbar fusion is considered to the gold standard for treatment of spinal degenerative diseases but results in adjacent segment degeneration and acquired spinal instability. Total disc replacement is a relatively new alternative avoiding the occurrence of the above complications. The systematic review and meta-analysis was designed to evaluate whether total disc replacement exhibited better outcomes and safety.
PubMed, Web of Science, Embase, the Cochrane Library, Chinese National Knowledge Infrastructure Database(CNKI), Wangfang database, and VIP database were searched for RCTs comparing total disc replacement with lumbar fusion. All statistical analyses were carried out using the RevMan5.3 and STATA12.0 software.
Of 1116 citations identified by our search strategy, 14 RCTs met the inclusion criteria. Compared to lumbar fusion, total disc replacement significantly improved ODI, VAS, SF-36, patient satisfaction, overall success, reoperation rate, ODI successful, reduced operation time, shortened duration of hospitalization, decreased postsurgical complications. However, total disc replacement did not show a significant difference regarding blood loss, consumption of analgesics, neurologic success and device success with lumbar fusion. And charges were significantly lower for total disc replacement compared with lumbar fusion in the 1-level patient group, while charges were similar in the 2-level group.
Total disc replacement is recommended to alleviate the pain of degenerative lumbar diseases, improve the state of lumbar function and the quality of life of patients, provide a high level of security, have better health economics benefits for 1-level patients.
腰椎融合术被认为是治疗脊柱退行性疾病的金标准，但会导致相邻节段退变和获得性脊柱不稳定。全椎间盘置换术是一种相对较新的替代方法，可避免上述并发症的发生。本系统评价和荟萃分析旨在评估全椎间盘置换术是否具有更好的疗效和安全性。
检索PubMed、Web of Science、Embase、Cochrane图书馆、中国知网数据库（CNKI）、万方数据库和维普数据库，查找比较全椎间盘置换术与腰椎融合术的随机对照试验。所有统计分析均使用RevMan5.3和STATA12.0软件进行。
通过我们的检索策略共识别出1116篇文献，其中14项随机对照试验符合纳入标准。与腰椎融合术相比，全椎间盘置换术显著改善了腰椎功能障碍指数（ODI）、视觉模拟评分（VAS）、简明健康状况调查量表（SF-36）、患者满意度、总体成功率、再次手术率、ODI成功率，缩短了手术时间、住院时间，减少了术后并发症。然而，在失血、镇痛药使用、神经功能成功率和器械成功率方面，全椎间盘置换术与腰椎融合术相比无显著差异。在单节段患者组中，全椎间盘置换术的费用显著低于腰椎融合术，而在双节段组中费用相似。
推荐全椎间盘置换术用于缓解退行性腰椎疾病的疼痛，改善腰椎功能状态和患者生活质量，提供较高的安全性，对单节段患者具有更好的卫生经济学效益。
