内镜与微创经椎间孔腰椎椎体间融合术治疗腰椎退行性疾病的临床疗效及并发症比较：一项系统评价与Meta分析

Comparison of clinical outcomes and complications between endoscopic and minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative diseases: a systematic review and meta-analysis.

作者信息

Haibier Abuduwupuer, Yusufu Alimujiang, Hang Lin, Abudurexiti Tuerhongjiang

机构信息

XinJiang Medical University, Urumqi, 830054, Xinjiang Uygur Autonomous Region, People's Republic of China.

Department of Orthopedics of Trauma, The Sixth Affiliated Hospital of Xinjiang Medical University, Orthopedic Hospital of Xinjiang Uygur Autonomous Region, No.39 Wuxing Road, Urumqi, 830002, Xinjiang Uygur Autonomous Region, People's Republic of China.

出版信息

J Orthop Surg Res. 2024 Jan 27;19(1):92. doi: 10.1186/s13018-024-04549-7.

DOI:10.1186/s13018-024-04549-7

PMID:38281015

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10821211/

Abstract

OBJECTIVE

This study compares the efficacy and complications of endoscopic transforaminal lumbar fusion (Endo-TLIF) and minimally invasive transforaminal lumbar fusion (MIS-TLIF) in treating lumbar degenerative diseases. It aims to provide reference data for clinical decision-making.

METHODS

We identified randomized controlled studies and non-randomized controlled studies on Endo-TLIF and MIS-TLIF for treating lumbar degenerative diseases based on specific inclusion and exclusion criteria. Data were managed with Endnote X9 software and meta-analyzed using Revman 5.3 software. Extracted outcomes included lower back VAS score, lower extremity pain VAS score, low back pain ODI score, complication rate, fusion rate, time to surgery, blood loss, and length of hospital stay.

RESULTS

① Thirteen high-quality studies were included in this meta-analysis, totaling 1015 patients-493 in the Endo-TLIF group and 522 in the MIS-TLIF group. ② Meta-analysis results revealed no significant differences in preoperative, postoperative 6-month, and final follow-up waist VAS scores, lower limb pain VAS score, ODI index, complications, and fusion rate between the two groups (P > 0.05). The MIS-TLIF group had a shorter operative time (MD = 29.13, 95% CI 10.86, 47.39, P = 0.002) than the Endo-TLIF group. However, the Endo-TLIF group had less blood loss (MD = - 76.75, 95% CI - 111.59, - 41.90, P < 0.0001), a shorter hospital stay (MD = - 2.15, 95% CI - 2.95, - 1.34, P < 0.00001), and lower lumbar VAS scores both immediately postoperative (≤ 2 week) (MD = - 1.12, 95% CI - 1.53, - 0.71, P < 0.00001) compared to the MIS-TLIF group.

CONCLUSION

Meta-analysis results indicated that Endo-TLIF is similar to MIS-TLIF in terms of long-term clinical outcomes, fusion rates, and complication rates. Although MIS-TLIF has a shorter operation time, Endo-TLIF can significantly reduce blood loss and hospital stay duration. Endo-TLIF offers the advantages of less surgical trauma, reduced blood loss, faster recovery, and early alleviation of postoperative back pain.

摘要

目的

本研究比较内镜下经椎间孔腰椎融合术（Endo-TLIF）与微创经椎间孔腰椎融合术（MIS-TLIF）治疗腰椎退行性疾病的疗效及并发症，旨在为临床决策提供参考数据。

方法

根据特定的纳入和排除标准，确定关于Endo-TLIF和MIS-TLIF治疗腰椎退行性疾病的随机对照研究和非随机对照研究。数据采用Endnote X9软件进行管理，并使用Revman 5.3软件进行荟萃分析。提取的结局指标包括下腰部视觉模拟评分（VAS）、下肢疼痛VAS评分、下腰痛Oswestry功能障碍指数（ODI）评分、并发症发生率、融合率、手术时间、失血量及住院时间。

结果

① 本荟萃分析纳入13项高质量研究，共1015例患者，其中Endo-TLIF组493例，MIS-TLIF组522例。② 荟萃分析结果显示，两组术前、术后6个月及末次随访时的腰部VAS评分、下肢疼痛VAS评分、ODI指数、并发症及融合率差异均无统计学意义（P＞0.05）。MIS-TLIF组手术时间短于Endo-TLIF组（MD = 29.13，95%CI 10.86，47.39，P = 0.002）。然而，Endo-TLIF组失血量更少（MD = -76.75，95%CI -111.59，-41.90，P＜0.0001），住院时间更短（MD = -2.15，95%CI -2.95，-1.34，P＜0.00001），且术后即刻（≤2周）下腰部VAS评分更低（MD = -1.12，95%CI -1.53，-0.71，P＜0.00001）。