单纯减压与融合术及Coflex治疗腰椎退行性疾病的比较：一项网状Meta分析。
Decompression alone versus fusion and Coflex in the treatment of lumbar degenerative disease: A network meta-analysis.
作者信息
Fan Yunpeng, Zhu Liulong
机构信息
Department of Orthopedic Surgery, The Affiliated Hangzhou Hospital of Nanjing Medical University.
The Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
出版信息
Medicine (Baltimore). 2020 Mar;99(11):e19457. doi: 10.1097/MD.0000000000019457.
BACKGROUND
Lumbar degenerative disease (LDD) is a very common disease. And decompression alone, posterior lumbar interbody fusion (PLIF), and interspinous device (Coflex) are generally accepted surgical techniques. However, the effectiveness and safety of the above techniques are still not clear. Network meta-analysis a comprehensive technique can compare multiple treatments based on indirect dates and all interventions are evaluated and ranked simultaneously. To figure out this problem and offer a better choice for LDD, we performed this network meta-analysis.
METHODS
PubMed and WanFang databases were searched based on the following key words, "Coflex," "decompression," "PLIF," "Posterior Lumbar Interbody Fusion," "Coflex" "Lumbar interbody Fusion." Then the studies were sorted out on the basis of inclusion criteria and exclusion criteria. A network meta-analysis was performed using The University of Auckland, Auckland city, New Zealand R 3.5.3 software.
RESULTS
A total of 10 eligible literatures were finally screened, including 946 patients. All studies were randomized controlled trials (RCTs). Compared with decompression alone group, there were no significant differences of Oswestry Disability Index (ODI) in Coflex and lumbar interbody fusion groups after surgery. However, Coflex and PLIF were better in decreasing Visual Analogue Scale (VAS) score compared with decompression alone. Furthermore, we found Coflex have a less complication incidence rate.
CONCLUSION
Compared with decompression alone, Coflex and lumbar interbody fusion had the similar effectiveness in improving lumbar function and quality of life. However, the latter 2 techniques were better in relieving pain. Furthermore, Coflex included a lower complication incidence rate. So we suggested that Coflex technique was a better choice to cue lumbar spinal stenosis (LSS).
LEVEL OF EVIDENCE
Systematic review and meta-analysis, level I.
背景
腰椎退行性疾病（LDD）是一种非常常见的疾病。单纯减压、后路腰椎椎间融合术（PLIF）和棘突间装置（Coflex）是普遍认可的手术技术。然而，上述技术的有效性和安全性仍不明确。网络荟萃分析作为一种综合技术，可以基于间接数据比较多种治疗方法，并且同时对所有干预措施进行评估和排序。为了解决这个问题并为LDD提供更好的选择，我们进行了这项网络荟萃分析。
方法
基于以下关键词检索PubMed和万方数据库：“Coflex”“减压”“PLIF”“后路腰椎椎间融合术”“Coflex”“腰椎椎间融合术”。然后根据纳入标准和排除标准对研究进行整理。使用新西兰奥克兰市奥克兰大学的R 3.5.3软件进行网络荟萃分析。
结果
最终共筛选出10篇符合条件的文献，包括946例患者。所有研究均为随机对照试验（RCT）。与单纯减压组相比，Coflex组和腰椎椎间融合组术后的奥斯威斯残疾指数（ODI）无显著差异。然而，与单纯减压相比，Coflex和PLIF在降低视觉模拟评分（VAS）方面效果更好。此外，我们发现Coflex的并发症发生率较低。
结论
与单纯减压相比，Coflex和腰椎椎间融合术在改善腰椎功能和生活质量方面效果相似。然而，后两种技术在缓解疼痛方面效果更好。此外，Coflex的并发症发生率较低。因此，我们建议Coflex技术是治疗腰椎管狭窄症（LSS）的更好选择。
证据水平
系统评价和荟萃分析，I级。
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