腰椎间盘置换和腰椎融合治疗腰椎间盘退行性病变疗效比较的Meta分析

发布时间：2018-05-02 14:31

  本文选题：腰椎间盘置换 + 腰椎融合　； 参考：《吉林大学》2015年硕士论文

【摘要】：背景： 腰椎融合术一直是治疗腰椎间盘退行性疾病的金标准，但是容易加速相邻节段的退变，产生新的不稳及疼痛，腰椎间盘置换术被认为可以通过保留病变节段的运动功能从而避免融合手术所带来的不良后果，但对其安全性及有效性是否优于融合手术仍然存在争议。 目的： 系统评价腰椎间盘置换术与腰椎融合术治疗腰椎间盘退变性疾病疗效及安全性的差异 方法： 综合检索PubMed、EMBASE、BIOSIS、OVID、COCHRANE图书馆、中国生物医学文献数据库、CNKI等数据库中腰椎间盘置换与腰椎融合治疗退变性腰椎病的随机对照研究文献,手工检索中文文献;两名研究者独立进行文献提取、纳入文献的方法学质量评价、评估偏倚风险及数据提取。这些文献中,实验组采用椎间盘置换术,而对照组采用腰椎融合术。采用Revman5.3软件对所提取数据进行Meta分析 结果： 共纳入5篇随机对照试验，患者共1506例，，其中腰椎融合组490例，腰椎间盘置换组1016例。Meta分析结果显示:在平均手术时间(MD=�c44.12，95%CI[�c94.73，�c6.49]，P=0.09)、平均术中失血量(MD=�c29.41，95%CI[ 173.84,115.01]，P=0.69),、再手术率(OR=0.76，95%CI[0.50，1.13]，P=0.18)、术后重返工作状态(OR=1.08，95%CI[0.84，1.38]，P=0.56)及术后镇痛药使用情况（OR=0.61，95%CI[0.35，1.06]，P=0.08）等方面，腰椎间盘置换组与腰椎融合组无统计学差异。而腰椎间盘置换组在术后VAS评分(MD=�c5.65,95%CI[ 9.11，�c2.19]，P=0.001)、术后ODI指数(MD=�c5.36，95%CI[ 7.90，�c2.82]， P＜0.0001)、并发症发生率（OR=0.41，95%CI[0.29，0.57]，P＜0.0001)、平均住院时间(MD=�c0.82,95%CI[ 1.38,�c0.26] P=0.004)、患者满意度（OR=2.08，95%CI[1.54，2.81]，P＜0.00001)及再次选择同一手术意愿(OR=2.12，95%CI[1.64，2.75]，P＜0.00001)等方面明显优于腰椎融合组。 结论： 腰椎间盘置换在近期临床有效性方面要优于腰椎融合，但是远期的疗效仍需要进一步验证。
[Abstract]:Background: Lumbar fusion has always been the gold standard for the treatment of lumbar disc degenerative diseases, but it is easy to accelerate the degeneration of adjacent segments, resulting in new instability and pain. Lumbar disc replacement is considered to be able to avoid the adverse consequences of fusion surgery by preserving the motor function of the diseased segment, but whether its safety and effectiveness is better than that of fusion surgery is still controversial. Objective: Systematic evaluation of the efficacy and safety of lumbar disc replacement and lumbar fusion in the treatment of lumbar disc degeneration Methods: Objective: to search the literature of randomized controlled study of lumbar disc replacement and lumbar fusion for degenerative lumbar spondylopathy in PubMedus EMBASEI Biospectral Library and Chinese Biomedical Literature Database (CNKI), and to search Chinese literature manually. The two researchers independently carried out literature extraction, including methodological quality evaluation, bias risk assessment and data extraction. In the literature, intervertebral disc replacement was performed in the experimental group and lumbar fusion in the control group. Meta Analysis of extracted data with Revman5.3 Software Results: A total of 1506 patients were included in 5 randomized controlled trials, including the lumbar fusion group. 鑵版�庨棿鐩樼疆鎹㈢�

本文编号：1834301