后路腰椎融合术与棘突间撑开术对单节段腰椎退行性疾病疗效的影响的Meta分析

发布时间：2019-03-07 19:50

【摘要】：[背景及目的]后路腰椎融合术是治疗腰椎退行性疾病的首选方法,然而它的地位目前受到棘突间撑开术的挑战,本系统综述旨在评估两种外科干预手段(后路腰椎融合术与棘突间撑开术)在治疗单节段腰椎退行性病变的疗效及安全性方面是否具有可比性。[方法]通过使用计算机系统检索至2015年3月为止的与比较后路腰椎融合术和棘突间撑开术干预单节段腰椎退行性病变相关的文献,其中被纳入的数据库包括Medline、 Cochrane、CBM、中国知网、万方及维普数据库等。收集相关的临床对照试验及随机对照试验后,依据规定的纳入标准及排除标准,予以对文献逐个行质量评估。然后使用RevMan4.2系统评估软件对可以合并分析的数据进行Meta分析,最后得出相关结论。[结果]筛选获取的所有文献,最后共20篇文献、1292名患者符合纳入标准并进行了Meta分析。综合分析结果表明：棘突间撑开组的手术时间、术中出血量均明显少于后路腰椎融合组,棘突间撑开组的住院时间也少于后路腰椎融合组。短期随访结果在VAS、JOA、ODI(%)评分上,两组间无明显差异,故可认为棘突间撑开术在减少手术时间及术中出血量的同时可取得与后路腰椎融合术相类似的临床疗效。在影像学上,棘突间撑开组可保留部分手术节段活动度,减少对邻近节段(头端)活动度的代偿性增加,这可能有效避免／减缓邻近节段病变的发生／进程。[结论]棘突间撑开术创伤小、恢复快,短期疗效与后路腰椎融合术无明显差异,但仍需长期临床结果的验证以及纳入更多的高质量的随机对照试验以做进一步评估。
[Abstract]:[background & objective] posterior lumbar fusion is the first choice for the treatment of lumbar degenerative diseases, but its position is currently challenged by interspinous protrusion. The purpose of this review is to evaluate the comparability of the efficacy and safety of two surgical interventions (posterior lumbar fusion and spinous protrusion) in the treatment of single-segment lumbar degenerative diseases. [methods] A computer system was used to search the literatures up to March 2015 related to the comparison of posterior lumbar fusion and interspinous protrusion in the intervention of single-segment lumbar degenerative lesions. The included databases included Medline, Cochrane,CBM,. China knowledge website, Wanfang and Weipu database and so on. After collecting relevant clinical controlled trials and randomized controlled trials, the quality of the literature was evaluated on a case-by-case basis according to the prescribed inclusion criteria and exclusion criteria. Then the RevMan4.2 system evaluation software is used to analyze the data that can be combined and analyzed by Meta. Finally, the relevant conclusions are drawn. [results] A total of 20 articles were selected and 1292 patients met the inclusion criteria and were analyzed by Meta. The results of comprehensive analysis showed that the operative time and the amount of intraoperative bleeding in the interspinous protrusion group were significantly less than those in the posterior lumbar fusion group, and the hospitalization time in the spinous process distraction group was also shorter than that in the posterior lumbar fusion group. There was no significant difference in the VAS,JOA,ODI (%) score between the two groups in short-term follow-up. Therefore, it can be concluded that interspinous protrusion can reduce the time of operation and the amount of bleeding during the operation, and the clinical effect is similar to that of the posterior lumbar fusion. In imaging, partial segment activity can be preserved in the spinous process open group, and the compensatory increase of the adjacent segment (head end) can be reduced, which may effectively avoid / slow down the occurrence / progression of the adjacent segment disease. [conclusion] there is no significant difference in short-term efficacy between interspinous protrusion and posterior lumbar fusion, but long-term clinical results need to be verified and more high-quality randomized controlled trials are included for further evaluation. [conclusion] there is no significant difference in short-term efficacy and posterior lumbar fusion between spinous protrusion and interspinous protrusion.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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