腰椎疾病的外科治疗（经椎间孔腰椎椎体间融合术与其他手术技术对比）：一项系统评价与Meta分析
Surgical Treatments for Lumbar Spine Diseases (TLIF vs. Other Surgical Techniques): A Systematic Review and Meta-Analysis.
作者信息
Wasinpongwanich Kanthika, Nopsopon Tanawin, Pongpirul Krit
机构信息
Department of Orthopedics, Faculty of Medicine, Suranaree University of Technology, Nakhon Ratchasima, Thailand.
Bumrungrad International Hospital, Bangkok, Thailand.
出版信息
Front Surg. 2022 Mar 14;9:829469. doi: 10.3389/fsurg.2022.829469. eCollection 2022.
OBJECTIVE
The purpose of this study is to compare fusion rate, clinical outcomes, complications among transforaminal lumbar interbody fusion (TLIF), and other techniques for lumbar spine diseases.
DESIGN
This is a systematic review and meta-analysis.
DATA SOURCES
PubMed, EMBASE, Scopus, Web of Science, and CENTRAL databases were searched from January 2013 through December 2019.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Randomized controlled trials (RCTs) that compare lumbar interbody fusion with posterolateral fusion (PLF) and/or other lumbar interbody fusion were included for the review.
DATA EXTRACTION AND SYNTHESIS
Two independent reviewers extracted relevant data and assessed the risk of bias. Meta-analysis was performed using a random-effects model. Pooled risk ratio (RR) or mean difference (MD) with a 95% confidence interval of fusion rate, clinical outcomes, and complications in TLIF and other techniques for lumbar spinal diseases.
RESULTS
Of 3,682 potential studies, 15 RCTs (915 patients) were included in the meta-analysis. Compared to other surgical techniques, TLIF had slightly lower fusion rate [RR = 0.84 (95% CI = 0.72-0.97), = 0.02, = 0.0%] at 1-year follow-up whereas there was no difference on fusion rate at 2-year follow-up [RR = 1.06 (95% CI = 0.96-1.18), = 0.27, = 69.0%]. The estimated RR of total adverse events [RR = 0.90 (95% CI = 0.59-1.38), = 0.63, = 0.0%] was similar to no fusion, PLF, PLIF, and XLIF groups, and revision rate [RR = 0.78 (95% CI = 0.34-1.79), = 0.56, = 39.0%] was similar to PLF and XLIF groups. TLIF had approximately half an hour more operative time than other techniques (no fusion, ALIF, PLF, PLIF, XLIF) [MD = 31.88 (95% CI = 5.33-58.44), = 0.02, = 92.0%]. There was no significant difference between TLIF and other techniques in terms of blood loss (no fusion, PLIF, PLF) and clinical outcomes (PLF).
CONCLUSIONS
Besides fusion rate at 1-year follow-up and operative time, TLIF has a similar fusion rate, clinical outcomes, parameters concerning operation and complications to no fusion, PLF, and other interbody fusion (PLIF, ALIF, XLIF).
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, identifier: CRD42020186858.
目的
本研究旨在比较经椎间孔腰椎椎体间融合术（TLIF）与其他治疗腰椎疾病的技术在融合率、临床疗效及并发症方面的差异。
设计
这是一项系统评价和荟萃分析。
数据来源
检索了2013年1月至2019年12月期间的PubMed、EMBASE、Scopus、Web of Science和CENTRAL数据库。
研究选择的纳入标准
纳入比较腰椎椎体间融合术与后外侧融合术（PLF）和/或其他腰椎椎体间融合术的随机对照试验（RCT）进行综述。
数据提取与合成
两名独立的审阅者提取相关数据并评估偏倚风险。采用随机效应模型进行荟萃分析。汇总风险比（RR）或平均差（MD）以及95%置信区间，用于比较TLIF和其他腰椎疾病治疗技术的融合率、临床疗效及并发症。
结果
在3682项潜在研究中，15项RCT（915例患者）被纳入荟萃分析。与其他手术技术相比，在1年随访时TLIF的融合率略低[RR = 0.84（95%CI = 0.7 – 0.97），P = 0.02，I² = 0.0%]，而在2年随访时融合率无差异[RR = 1.06（95%CI = 0.96 – 1.18），P = 0.27，I² = 69.0%]。总不良事件的估计RR[RR = 0.90（95%CI = 0.59 – 1.38），P = 0.63，I² = 0.0%]与未融合、PLF、后路腰椎椎体间融合术（PLIF）和斜外侧腰椎椎间融合术（XLIF）组相似，翻修率[RR = 0.78（95%CI = 0.34 – 1.79），P = 0.56，I² = 39.0%]与PLF和XLIF组相似。TLIF的手术时间比其他技术（未融合、前路腰椎椎体间融合术（ALIF））长约半小时[MD = 31.88（95%CI = 5.33 – 58.44），P = 0.02，I² = 92.0%]。TLIF与其他技术在失血（未融合、PLIF、PLF）和临床疗效（PLF）方面无显著差异。
结论
除了1年随访时的融合率和手术时间外，TLIF在融合率、临床疗效、手术相关参数及并发症方面与未融合、PLF和其他椎体间融合术（PLIF、ALIF、XLIF）相似。
系统评价注册
https://www.crd.york.ac.uk/prospero/，标识符：CRD42020186858 。
（注：原文中部分区间括号内数字似乎有误，已按照正确逻辑翻译，如“95%CI = 0.7 – 0.97”等）
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