系统评价和荟萃分析前路腰椎体间融合术治疗骨科脊柱滑脱的临床疗效。
A systematic review and meta-analysis of the clinical efficacy of anterior lumbar interbody fusion in the treatment of orthopedic spondylolisthesis.
机构信息
Department of Orthopedic Surgery, Fifth People's Hospital of Chongqing, University of Chinese Academy of Sciences Chongqing Renji Hospital, Chongqing, China.
Department of Orthopedics, Seventh People's Hospital of Chongqing, Chongqing, China.
出版信息
Ann Palliat Med. 2021 Dec;10(12):12607-12617. doi: 10.21037/apm-21-3330.
BACKGROUND
Many studies have reported the advantages of anterior lumbar interbody fusion (ALIF), but the technique is associated with many complications involving nerve injury. This meta-analysis compared the outcome indicators associated with 2 fusion methods, namely, ALIF and posterolateral fusion (PLF). The clinical efficacy of ALIF was explored to provide evidence-based data for the determination of surgical methods for treating orthopedic spondylolisthesis.
METHODS
Relevant literatures were retrieved from the CBMdisc, CNKI, PubMed, EBSCO, MEDLINE, Science Direct, and Cochrane databases. Keywords in Chinese and English included spondylolisthesis, spine, surgical treatment, ALIF, and PLF. Data including the visual analogue scale (VAS) score, the Oswestry Disability Index (ODI), time of operation, and fusion rate were collated. According to Cochrane manual, Rev Man 5.3 software was used for analysis.
RESULTS
A total of 6 articles were included in this meta-analysis. There were significant differences in intraoperative blood loss [Z=3.34; mean difference (MD) =-142.54; 95% confidence interval (CI): -226.17 to -58.92; P=0.0008] and operation time (Z=5.45; MD =-54.31; 95% CI: -73.83 to -34.79; P<0.00001) between patients in the ALIF group and patients in the PLF group. Significant differences were observed in VAS score (Z=3.55; MD =-1.04; 95% CI: -1.62 to -0.47; P=0.0004) nor ODI score (Z=3.07; MD =-6.33; 95% CI: -10.37 to -2.28; P=0.002) between the ALIF group and the PLF group. Interestingly, there was a significant difference in the hospitalization time between the 2 groups (Z=2.39; MD=-1.48; 95% CI: -2.70 to -0.27; P=0.02). Bone fusion rate was no significantly different between patients in the ALIF group and patients in the PLF group [Z=0.43; odds ratio (OR) =0.42; 95% CI: 0.01 to 21.82; P=0.66].
DISCUSSION
The results of this meta-analysis confirmed that ALIF can effectively improve the degree of spondylolisthesis, provide superior structural stability, and ensure surgical efficacy.
背景
许多研究报告了前路腰椎体间融合术（ALIF）的优势，但该技术与许多涉及神经损伤的并发症有关。本荟萃分析比较了两种融合方法（ALIF 和后外侧融合术（PLF））相关的结局指标。探讨了 ALIF 的临床疗效，为确定治疗骨科脊椎滑脱的手术方法提供循证数据。
方法
从 CBMdisc、CNKI、PubMed、EBSCO、MEDLINE、Science Direct 和 Cochrane 数据库中检索相关文献。中文和英文关键词包括脊椎滑脱、脊柱、手术治疗、ALIF 和 PLF。整理的数据包括视觉模拟评分（VAS）、Oswestry 功能障碍指数（ODI）、手术时间和融合率。根据 Cochrane 手册，使用 Rev Man 5.3 软件进行分析。
结果
这项荟萃分析共纳入 6 篇文章。ALIF 组和 PLF 组患者在术中出血量[Z=3.34；MD=-142.54；95%置信区间（CI）：-226.17 至-58.92；P=0.0008]和手术时间[Z=5.45；MD=-54.31；95%CI：-73.83 至-34.79；P<0.00001]方面存在显著差异。ALIF 组和 PLF 组在 VAS 评分[Z=3.55；MD=-1.04；95%CI：-1.62 至-0.47；P=0.0004]和 ODI 评分[Z=3.07；MD=-6.33；95%CI：-10.37 至-2.28；P=0.002]方面无显著差异。有趣的是，两组患者的住院时间存在显著差异[Z=2.39；MD=-1.48；95%CI：-2.70 至-0.27；P=0.02]。ALIF 组和 PLF 组患者的骨融合率无显著差异[Z=0.43；OR=0.42；95%CI：0.01 至 21.82；P=0.66]。
讨论
这项荟萃分析的结果证实，ALIF 可有效改善脊椎滑脱程度，提供更好的结构稳定性，并确保手术疗效。
Zotero 插件