经Quadrant通道微创TLIF术与传统开放TLIF术治疗腰椎退行性病变的Meta分析
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摘要
目的比较Quadrant通道经椎间孔腰椎融合术(transforaminal lumbar interbody fusion,TLIF)和传统TLIF术治疗腰椎退行性疾病的临床效果,为Quadrant通道TLIF术的临床应用提供循证医学证据。方法手工检索骨科相关杂志,计算机系统检索中英文数据库,收集并纳入关于比较Quadrant通道TLIF术与传统TLIF术治疗椎间盘退行性变的相关随机对照临床研究。提取纳入文献中的数据并使用Rev Man 5.2软件进行Meta分析。结果纳入5篇文献共计患者326例,其中mini-TLIF组145例,open-TLIF组181例。mini-TLIF组比open-TLIF组术后出血量少、住院时间短、术后周围肌肉组织水肿消散早、术后早期缓解疼痛效果好。二者长期的功能评分无明显差异,但mini-TLIF组存在术中透视时间长,对医护人员、患者的X线暴露时间增加的缺点。结论 Quadrant通道TLIF术与传统TLIF术长期临床疗效及安全性比较,无明显差异。Quadrant通道TLIF术在出血量、住院时间、术后周围肌肉组织水肿消散、早期缓解疼痛方面有显著优越性。Quadrant通道TLIF的不足之处是术中透视时间长。
Objective To compare the clinical effect of minimally invasive transforaminal lumbar interbody fusion( TLIF) through Quadrant channel and conventional TLIF in the treatment of lumbar degenerative disease,aimed to provide evidence of evidence-based medicine for the clinical application of TLIF. Methods We searched journals of orthopedics by manual retrieval,and searched Chinese / English database by computer system. Randomize control studies comparing the effect of minimally invasive TLIF through Quadrant channel and conventional TLIF in the treatment of lumbar degenerative disease were collected in our study. Rev Man 5. 2 was used for meta analysis. Result Five studies involving a total of326 cases were recruited. Among them,145 cases were treated by Quadrant channel TLIF,and 181 cases were treated by normal TLIF. Compared with the traditional TLIF,Quadrant channel TLIF has less bleeding,shorter hospital stay,and postoperative peripheral muscle tissue edema. There was no significant difference in the functional scores of the two types of operation. However, the Quadrant channel TLIF had some disadvantages,such as longer fluoroscopy time,and longer X-ray exposure time. Conclusion The long-term clinical efficacy and safety of the two surgical procedures are similar. There are significant advantages in Quadrant channel TLIF in the amount of bleeding,hospitalization time,early pain relief and so on,but the fluoroscopy time during operation is too long.
Objective To compare the clinical effect of minimally invasive transforaminal lumbar interbody fusion( TLIF) through Quadrant channel and conventional TLIF in the treatment of lumbar degenerative disease,aimed to provide evidence of evidence-based medicine for the clinical application of TLIF. Methods We searched journals of orthopedics by manual retrieval,and searched Chinese / English database by computer system. Randomize control studies comparing the effect of minimally invasive TLIF through Quadrant channel and conventional TLIF in the treatment of lumbar degenerative disease were collected in our study. Rev Man 5. 2 was used for meta analysis. Result Five studies involving a total of326 cases were recruited. Among them,145 cases were treated by Quadrant channel TLIF,and 181 cases were treated by normal TLIF. Compared with the traditional TLIF,Quadrant channel TLIF has less bleeding,shorter hospital stay,and postoperative peripheral muscle tissue edema. There was no significant difference in the functional scores of the two types of operation. However, the Quadrant channel TLIF had some disadvantages,such as longer fluoroscopy time,and longer X-ray exposure time. Conclusion The long-term clinical efficacy and safety of the two surgical procedures are similar. There are significant advantages in Quadrant channel TLIF in the amount of bleeding,hospitalization time,early pain relief and so on,but the fluoroscopy time during operation is too long.
引文
[1]李永津,陈博来,林涌鹏.MAST Quadrant通道下微创TLIF与开放TLIF两种术式治疗腰椎退行性疾病的效果比较[J].广东医学,2012,33(9):1287-1289.
[2]Foley KT,Lefkowitz MA.Advances in minimally invasive spine surgery[J].Clin Neurosurg,2002,49(2):499-517.
[3]Wang HL,LüFZ,Jiang JY,et al.Minimally invasive lumbar interbody fusion via MAST Quadrant retractor versus open surgery:a prospective randomized clinical trial[J].Chin Med J(Engl),2011,124(23):3868-3874.
[4]闫国良,纪振钢,高浩然,等.微创经椎间孔减压腰椎融合内固定术与传统后路开放手术治疗腰椎退变性疾病的疗效比较[J].中国脊柱脊髓杂志,2013,23(3):244-250.
[5]王强,吴寅良,朱和平.Mast Quadrant微创通道与开放式经椎间孔腰椎椎间融合术的临床比较[J].脊柱外科杂志,2013,11(5):288-291.
[6]黄晓川.Quadrant微创通道椎间融合内固定术与开放椎间融合高固定术治疗腰椎间盘突出症疗效的比较[J].中国骨与关节杂志,2014,13(4):257-260.
[7]汤优,张为,申勇,等.经Quadrant通道下微创TLIF与开放TLIF治疗腰椎退变性疾病疗效的对比研究[J].中国矫形外科杂志,2012,20(21):1935-1938.
[8]Blume HG.Unilateral posterior lumbar interbody fusion slmplified dowel technique[J].Clin Orthop Relat Res,1985,(193):75-84.
[9]Rouben D,Casnellie M,Ferguson M.Long-term durability of minimal invasive posterior transforaminal lumbar interbody fusion:a clinical and radiographic follow-up[J].J Spinal Disord Tech,2011,24(5):288-296.
[10]林昊,何仿,王雷,等.改良经椎间孔椎体间融合术在治疗Ⅰ、Ⅱ度腰椎滑脱症中的运用[J].中国矫形外科杂志,2011,19(8):687-688.
[11]Glassman SD,Copay AG,Berven SH,et al.Defining substantial clinical benefit following lumbar spine arthrodesis[J].J Bone Joint Surg Am,2008,90(9):1839-1847.
[12]邵诗泽,张恩忠,付松,等.腰骶段多裂肌的形态特点及功能意义[J].中国临床解剖学杂志,2010,28(1):17-19.
[13]陈国平,洪天禄,李淑葵,等.多裂肌间隙入路手术治疗腰椎手术失败综合征[J].实用骨科杂志,2013,19(4):289-293.
[14]Bawa M,Schimizzi AL,Leek B,et al.Paraspinal muscle vasculature contributes to posterolateral spinal fusion[J].Spine,2006,31(8):891-896.
[15]范顺武,胡志军,方向前,等.小切口与传统开放术式行后路腰椎椎体间融合术对脊旁肌损伤的对比研究[J].中华骨科杂志,2009,29(11):1000-1004.
[16]孙常太,张启伟,申剑,等.经X-tube微创腰椎椎弓根螺钉内固定椎间融合术手术体会[J].脊柱外科杂志,2004,2(3):185-186.
[17]Aoki Y,Yamagata M,Nakajima FA,et al.Examining risk factors for posterior migration of fusion cages following transforaminal lumbar interbody fusion:a possible limitation of unilateral pedicle screw fixation[J].J Neurosurg Spine,2010,13(3):381-387.
[18]王庆敏,陈鲁峰,曾蔚林,等.经MAST Quadrant通道下微创腰椎融合术近期疗效观察[J].临床骨科杂志,2011,14(6):605-608.
[19]王志荣,陆爱清,杨惠林,等.Quadrant通道下TLIF术治疗复发性腰椎间盘突出症的疗效分析[J].中国脊柱脊髓杂志,2014,24(2):121-126.
[20]康辉,蔡贤华,徐峰,等.Quadrant通道下经椎间孔腰椎椎体间融合术治疗复发性腰椎间盘突出症的疗效[J].中国脊柱脊髓杂志,2013,23(3):198-203.
[21]刘涛,李长青,周跃,等.微创手术治疗Ⅰ、Ⅱ度腰椎滑脱症的疗效观察[J].中国脊柱脊髓杂志,2009,19(5):354-359.
[22]徐烁,党小伍,肖建春,等.Quadrant通道下微创手术治疗胸腰椎骨折的临床分析[J].中国临床解剖学杂志,2014,32(4):471-475.
[23]李卫东,崔志明,徐冠华,等.Mast Quadrant可扩张管通道微创手术系统治疗腰椎管狭窄症[J].脊柱外科杂志,2010,8(4):207-210.
[2]Foley KT,Lefkowitz MA.Advances in minimally invasive spine surgery[J].Clin Neurosurg,2002,49(2):499-517.
[3]Wang HL,LüFZ,Jiang JY,et al.Minimally invasive lumbar interbody fusion via MAST Quadrant retractor versus open surgery:a prospective randomized clinical trial[J].Chin Med J(Engl),2011,124(23):3868-3874.
[4]闫国良,纪振钢,高浩然,等.微创经椎间孔减压腰椎融合内固定术与传统后路开放手术治疗腰椎退变性疾病的疗效比较[J].中国脊柱脊髓杂志,2013,23(3):244-250.
[5]王强,吴寅良,朱和平.Mast Quadrant微创通道与开放式经椎间孔腰椎椎间融合术的临床比较[J].脊柱外科杂志,2013,11(5):288-291.
[6]黄晓川.Quadrant微创通道椎间融合内固定术与开放椎间融合高固定术治疗腰椎间盘突出症疗效的比较[J].中国骨与关节杂志,2014,13(4):257-260.
[7]汤优,张为,申勇,等.经Quadrant通道下微创TLIF与开放TLIF治疗腰椎退变性疾病疗效的对比研究[J].中国矫形外科杂志,2012,20(21):1935-1938.
[8]Blume HG.Unilateral posterior lumbar interbody fusion slmplified dowel technique[J].Clin Orthop Relat Res,1985,(193):75-84.
[9]Rouben D,Casnellie M,Ferguson M.Long-term durability of minimal invasive posterior transforaminal lumbar interbody fusion:a clinical and radiographic follow-up[J].J Spinal Disord Tech,2011,24(5):288-296.
[10]林昊,何仿,王雷,等.改良经椎间孔椎体间融合术在治疗Ⅰ、Ⅱ度腰椎滑脱症中的运用[J].中国矫形外科杂志,2011,19(8):687-688.
[11]Glassman SD,Copay AG,Berven SH,et al.Defining substantial clinical benefit following lumbar spine arthrodesis[J].J Bone Joint Surg Am,2008,90(9):1839-1847.
[12]邵诗泽,张恩忠,付松,等.腰骶段多裂肌的形态特点及功能意义[J].中国临床解剖学杂志,2010,28(1):17-19.
[13]陈国平,洪天禄,李淑葵,等.多裂肌间隙入路手术治疗腰椎手术失败综合征[J].实用骨科杂志,2013,19(4):289-293.
[14]Bawa M,Schimizzi AL,Leek B,et al.Paraspinal muscle vasculature contributes to posterolateral spinal fusion[J].Spine,2006,31(8):891-896.
[15]范顺武,胡志军,方向前,等.小切口与传统开放术式行后路腰椎椎体间融合术对脊旁肌损伤的对比研究[J].中华骨科杂志,2009,29(11):1000-1004.
[16]孙常太,张启伟,申剑,等.经X-tube微创腰椎椎弓根螺钉内固定椎间融合术手术体会[J].脊柱外科杂志,2004,2(3):185-186.
[17]Aoki Y,Yamagata M,Nakajima FA,et al.Examining risk factors for posterior migration of fusion cages following transforaminal lumbar interbody fusion:a possible limitation of unilateral pedicle screw fixation[J].J Neurosurg Spine,2010,13(3):381-387.
[18]王庆敏,陈鲁峰,曾蔚林,等.经MAST Quadrant通道下微创腰椎融合术近期疗效观察[J].临床骨科杂志,2011,14(6):605-608.
[19]王志荣,陆爱清,杨惠林,等.Quadrant通道下TLIF术治疗复发性腰椎间盘突出症的疗效分析[J].中国脊柱脊髓杂志,2014,24(2):121-126.
[20]康辉,蔡贤华,徐峰,等.Quadrant通道下经椎间孔腰椎椎体间融合术治疗复发性腰椎间盘突出症的疗效[J].中国脊柱脊髓杂志,2013,23(3):198-203.
[21]刘涛,李长青,周跃,等.微创手术治疗Ⅰ、Ⅱ度腰椎滑脱症的疗效观察[J].中国脊柱脊髓杂志,2009,19(5):354-359.
[22]徐烁,党小伍,肖建春,等.Quadrant通道下微创手术治疗胸腰椎骨折的临床分析[J].中国临床解剖学杂志,2014,32(4):471-475.
[23]李卫东,崔志明,徐冠华,等.Mast Quadrant可扩张管通道微创手术系统治疗腰椎管狭窄症[J].脊柱外科杂志,2010,8(4):207-210.