单纯减压与减压融合治疗腰椎管狭窄临床疗效的meta分析
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摘要
目的:系统评价单纯减压和减压融合治疗腰椎滑脱症的临床疗效。方法:检索Pubmed、EMBASE、Cochrane图书馆、CNKI、CBM、万方和维普数据库,检索时间至2018年8月,获取单纯减压和减压融合治疗腰椎管狭窄的随机对照试验(RCTs)。应用RevMan 5.3统计学软件进行分析比较两组患者手术时间、失血量、住院时间、再手术率和随访2年脊柱ODI评分情况。结果:共纳入5篇外文对照研究,包括438例患者;单纯减压组手术时间、住院时间、术中失血量明显低于减压融合组,差异有统计学意义(均P<0.05)。手术效果满意度、ODI评分和再手术率方面,单纯减压和减压融合相比,差异无统计学意义(P>0.05)。结论:单纯减压治疗腰椎管狭窄手术时间短、出血量少,疗效肯定,值得临床推广应用。
Objective:To compare the clinical efficacy between decompression alone and decompression combined with fusion for lumbar spinal stenosis.Methods:Pubmed,EMBASE,Cochrane library,CNKI,Wanfang and VIP database were searched.Randomized controlled trials(RCTs)which compared the clinical outcomes of decompression alone and decompression combined with fusion for lumbar spinal stenosis were included.The meta analysis was performed with RevMan 5.3.Results:There were 5 RCTs involving 438 patients were included in this review.The operation time,hospital days and blood loss in patients who only received the treatment of decompression were superior to those received the combination of decompression and fusion(P<0.05),whereas no significant difference was noted in the satisfaction rate of operation,ODI score and reoperation rate between the two methods(P>0.05).Conclusion:Decompression alone has advantages in the treatment of lumbar spinal stenosis,such as shorter operation time,less blood loss and satisfactory efficacy.
Objective:To compare the clinical efficacy between decompression alone and decompression combined with fusion for lumbar spinal stenosis.Methods:Pubmed,EMBASE,Cochrane library,CNKI,Wanfang and VIP database were searched.Randomized controlled trials(RCTs)which compared the clinical outcomes of decompression alone and decompression combined with fusion for lumbar spinal stenosis were included.The meta analysis was performed with RevMan 5.3.Results:There were 5 RCTs involving 438 patients were included in this review.The operation time,hospital days and blood loss in patients who only received the treatment of decompression were superior to those received the combination of decompression and fusion(P<0.05),whereas no significant difference was noted in the satisfaction rate of operation,ODI score and reoperation rate between the two methods(P>0.05).Conclusion:Decompression alone has advantages in the treatment of lumbar spinal stenosis,such as shorter operation time,less blood loss and satisfactory efficacy.
引文
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[9]胡伟,赵杰,巩陈,等.单侧椎板入路双侧减压治疗单侧症状为主腰椎管狭窄的疗效分析[J].中华医学杂志,2016,96(21):1673-1676.
[10]李辉,高延征,张琨,等.微创单侧与切开双侧椎弓根钉内固定治疗单间隙腰椎管狭窄的疗效比较[J].中国骨与关节损伤杂志,2017,32(9):965-966.
[11]白皓天,李建安,白云深,等.老年退变性腰椎侧凸并椎管狭窄长节段固定疗效[J].中国老年学杂志,2018,38(2):395-396.
[2]陈斌,王文己,李王丽.退变性腰椎管狭窄的骨科治疗:植入物固定与骨性融合[J].中国组织工程研究,2014(22):3581-3586.
[3]HERKOWITZ H N,KURZ L T.Degenerative lumbar spondylolisthesis with spinal stenosis.A prospective study comparing decompression with decompression and intertransverse process arthrodesis[J].J Bone Joint Surg Am,1991(73):802-808.
[4]GROB D,HUMKE T,DVORAK J.Degenerative lumbar spinal stenosis.Decompression with and without arthrodesis[J].J Bone Joint Surg Am,1995(77):1036-1041.
[5]HALLETT A,HUNTLEY J S,GIBSON J N.Foraminal stenosis and single-level degenerative disc disease:a randomized controlled trial comparing decompression with decompression and instrumented fusion[J].Spine Phila Pa,2007(32):1375-1380.
[6]GHOGAWALA Z,DZIURA J,BUTLER W E,et al.Laminectomy plus fusion versus laminectomy alone for lumbar spondylolisthesis[J].N Engl J Med,2016(374):1424-1434.
[7]FORSTH P,OLAFSSON G,CARLSSON T,et al.Arandomized,controlled trial of fusion surgery for lumbar spinal stenosis[J].N Engl J Med,2016(374):1413-1423.
[8]张楠,刘娜,丑凯平,等.神经根沉降征与重度中央型/混合型腰椎管狭窄受压节段硬膜囊横截面积变化的相关性研究[J].中国脊柱脊髓杂志,2016,26(10):919-925.
[9]胡伟,赵杰,巩陈,等.单侧椎板入路双侧减压治疗单侧症状为主腰椎管狭窄的疗效分析[J].中华医学杂志,2016,96(21):1673-1676.
[10]李辉,高延征,张琨,等.微创单侧与切开双侧椎弓根钉内固定治疗单间隙腰椎管狭窄的疗效比较[J].中国骨与关节损伤杂志,2017,32(9):965-966.
[11]白皓天,李建安,白云深,等.老年退变性腰椎侧凸并椎管狭窄长节段固定疗效[J].中国老年学杂志,2018,38(2):395-396.