PLIF与TLIF手术治疗退行性腰椎滑脱症的Meta分析
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摘要
目的对后路腰椎间融合术(PLIF)与经椎间孔入路腰椎间融合术(TLIF)治疗退行性腰椎滑脱症的临床疗效进行Meta分析。方法检索PubMed、EMBASE、Cochrane图书馆、CNKI、万方和维普数据库获取PLIF和TLIF治疗退行性腰椎滑脱症的临床对照研究。采用RevMan 5.3统计学软件分析PLIF组与TLIF组术中失血量、椎间融合率、并发症情况。结果纳入6篇文献,PLIF组378例,TLIF组254例。Meta分析结果显示,TLIF组术中失血量较PLIF组少,差异有统计学意义(P <0.05);但TLIF组与PLIF组椎间融合率比较差异无统计学意义(P>0.05)。在总体并发症发生率方面,PLIF组高于TLIF组,差异有统计学意义(P <0.05);而在感染和融合器移位这两种严重并发症发生率方面,PLIF组和TLIF组间差异无统计学意义(P>0.05)。结论与PLIF手术相比,TLIF手术治疗退行性腰椎滑脱症能够在保证手术疗效的前提下明显降低术后并发症发生率。
Objective To compare the clinical effect of posterior lumbar interbody fusion(PLIF) and transforaminal lumbar interbody fusion(TLIF) in treatment of lumbar spondylolisthesis with the Meta-analysis. Methods Pubmed, EMBASE,Cochrane library, CNKI, Wanfang and VIP database were searched to obtain RCTs about PLIF and TLIF in lumbar spondylolisthesis. RevMan 5.3 software was used to analyze the indicators of fusion rate, blood loss and complications.Results Six eligible RCTs involving 378 patients in PLIF and 254 patients in TLIF were included in this review. Meta-analysis showed that the rate of blood loss in PLIF was lower than those in TLIF(P <0.05). The rate of fusion rate showed no significant difference in two groups(P >0.05). The total complication rate in TLIF was lower than PLIF(P <0.05). But, there was no significant difference between TLIF and PLIF in infection and malposition(P >0.05). Conclusion Compared with PLIF, TLIF in the treatment of degenerative lumbar spondylolisthesis can significantly reduce the incidence of postoperative complications while ensuring the curative effect.
Objective To compare the clinical effect of posterior lumbar interbody fusion(PLIF) and transforaminal lumbar interbody fusion(TLIF) in treatment of lumbar spondylolisthesis with the Meta-analysis. Methods Pubmed, EMBASE,Cochrane library, CNKI, Wanfang and VIP database were searched to obtain RCTs about PLIF and TLIF in lumbar spondylolisthesis. RevMan 5.3 software was used to analyze the indicators of fusion rate, blood loss and complications.Results Six eligible RCTs involving 378 patients in PLIF and 254 patients in TLIF were included in this review. Meta-analysis showed that the rate of blood loss in PLIF was lower than those in TLIF(P <0.05). The rate of fusion rate showed no significant difference in two groups(P >0.05). The total complication rate in TLIF was lower than PLIF(P <0.05). But, there was no significant difference between TLIF and PLIF in infection and malposition(P >0.05). Conclusion Compared with PLIF, TLIF in the treatment of degenerative lumbar spondylolisthesis can significantly reduce the incidence of postoperative complications while ensuring the curative effect.
引文
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[4] Humphreys SC,Hodges SD,Patwardhan AG,et al. Comparison of posterior and transforaminal approaches to lumbar interbody fusion[J]. Spine(Phila Pa 1976),2001,26(5):567-571.
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[6]颜登鲁,李健,高梁斌,等.两种椎间植骨融合术治疗退行性腰椎滑脱症的疗效比较[J].中华外科杂志,2008,46(7):497-500.
[7] Mehta VA,McGirt MJ,Garces Ambrossi GL,et al. Trans-foraminal versus posterior lumbar interbody fusion:comparison of surgical morbidity[J]. Neurol Res,2011,33(1):38-42.
[8] Audat Z,Moutasem O,Yousef K,et al. Comparison of clinical and radiological results of posterolateral fusion,posterior lumbar interbodyfusion and transforaminal lumbar interbody fusion techniques in the treatment of degenerative lumbar spine[J]. Singapore Med J,2012,53(3):183-187.
[9] Sakeb N,Ahsan K. Comparison of the early results of transforaminal lumbar interbody fusion and posterior lumbar interbody fusion in symptomatic lumbar instability[J]. Indian J Orthop,2013,47(3):255-263.
[10] Mukai Y,Takenaka S,Hosono N,et al. Intramuscular pressure of the multifidus muscle and low-back pain after posterior lumbar interbody fusion:comparison of mini-open and conventional approaches[J]. J Neurosurg Spine,2013,19(6):651-657.
[11] Tian NF,Wu YS,Zhang XL,et al. Minimally invasive versus open transforaminal lumbar interbody fusion:a meta-analysis based on the current evidence[J]. Eur Spine J,2013,22(8):1741-1749.
[12] Singh K,Nandyala SV,Marquez-Lara A,et al. A perioperative cost analysis comparing single-level minimally invasive and open transforaminal lumbar interbody fusion[J]. Spine J,2014,14(8):1694-1701.
[2] Ye YP,Xu H,Chen D. Comparison between posterior lumbar interbody fusion and posterolateral fusion with transpedicular screw fixation for isthmic spondylolithesis:a meta-analysis[J]. Arch Orthop Trauma Surg,2013,133(12):1649-1655.
[3] Wu RH,Fraser JF,Hartl R. Minimal access versus open transforaminal lumbar interbody fusion:meta-analysis of fusion rates[J]. Spine(Phila Pa 1976),2010,35(26):2273-2281.
[4] Humphreys SC,Hodges SD,Patwardhan AG,et al. Comparison of posterior and transforaminal approaches to lumbar interbody fusion[J]. Spine(Phila Pa 1976),2001,26(5):567-571.
[5] Park JS,Kim YB,Hong HJ,et al. Comparison between posterior and transforaminal approaches for lumbar interbody fusion[J]. J Korean Neurosurg Soc,2005,37:340-344.
[6]颜登鲁,李健,高梁斌,等.两种椎间植骨融合术治疗退行性腰椎滑脱症的疗效比较[J].中华外科杂志,2008,46(7):497-500.
[7] Mehta VA,McGirt MJ,Garces Ambrossi GL,et al. Trans-foraminal versus posterior lumbar interbody fusion:comparison of surgical morbidity[J]. Neurol Res,2011,33(1):38-42.
[8] Audat Z,Moutasem O,Yousef K,et al. Comparison of clinical and radiological results of posterolateral fusion,posterior lumbar interbodyfusion and transforaminal lumbar interbody fusion techniques in the treatment of degenerative lumbar spine[J]. Singapore Med J,2012,53(3):183-187.
[9] Sakeb N,Ahsan K. Comparison of the early results of transforaminal lumbar interbody fusion and posterior lumbar interbody fusion in symptomatic lumbar instability[J]. Indian J Orthop,2013,47(3):255-263.
[10] Mukai Y,Takenaka S,Hosono N,et al. Intramuscular pressure of the multifidus muscle and low-back pain after posterior lumbar interbody fusion:comparison of mini-open and conventional approaches[J]. J Neurosurg Spine,2013,19(6):651-657.
[11] Tian NF,Wu YS,Zhang XL,et al. Minimally invasive versus open transforaminal lumbar interbody fusion:a meta-analysis based on the current evidence[J]. Eur Spine J,2013,22(8):1741-1749.
[12] Singh K,Nandyala SV,Marquez-Lara A,et al. A perioperative cost analysis comparing single-level minimally invasive and open transforaminal lumbar interbody fusion[J]. Spine J,2014,14(8):1694-1701.