| Abstract | 背景：目前腰椎滑脱主要的外科治疗手段为后外侧植骨融合和环周融合术。
目的：系统评价后外侧植骨融合术对比360°环周融合术治疗腰椎滑脱症的有效性和安全性。
方法：计算机检索PubMed、the Cochrane Library、Web of Knowledge、万方（Wanfang）、中文科技期刊全文数据库（VIP）、中国知网（CNKI），检索时间均从建库开始截止2014年7月。查找后外侧植骨融合术（PLF）与360°环周融合术（CF）治疗腰椎滑脱症的随机对照试验（RCT），采用Meta分析软件RevMan 5.2进行数据分析。
结果：最终纳入3个RCT，4个回顾性研究，共计623例患者，其中PLF组326例，CF组297例，患者年龄在19～70岁之间不等，随访时间最长为4年。Meta分析显示：比较360°环周融合术，后外侧植骨融合术可明显缩短手术时间（MD = -71.08, 95%CI:-122.63 ～ -19.54, p = 0.007）和住院时间（MD = -0.98, 95%CI:-1.85～-0.11, p = 0.03），减少术中出血量（MD = -174.66, 95%CI:-304.59 ～ -44.72, p = 0.008），提高脊柱融合率（OR = 0.12, 95%CI:0.04～0.35, p<0.0001），改善患者6个月(MD = 24.87, 95%CI: 22.84～26.90, p<0.00001）、12个月（MD = -1.21, 95%CI: -2.13 ～ -0.29, p=0.01）、24个月（MD = -8.66, 95%CI: -9.54 ～ -7.78, p<0.00001）躯体功能评分和6个月(MD = -5.09, 95%CI: -6.18 ～ -4.00, p<0.00001）、12个月（MD = -8.28, 95%CI: -9.24 ～ -7.32, p<0.00001）、24个月(MD = -9.91, 95%CI: -10.83 ～ -8.99, p<0.00001）躯体疼痛评分，但不能明显改善患者6个月（MD = 8.08, 95%CI:1.23 ～ 14.94, p=0.02）、12个月（MD=6.72, 95%CI:6.02 ～ 7.42, p<0.00001）及24个月（MD = 4.94, 95%CI:4.30 ～ 5.57, p<0.00001）Oswestry功能障碍指数和6个月（MD = 17.00, 95%CI: 12.89 ～ 21.11, p<0.00001）、12个月（MD = 7.00, 95%CI: 1.78 ～ 12.22, p=0.009）的AAOS评分。然而，在并发症发生率(OR = 1.16, 95%CI:0.51 ～ 2.62, p=0.72），患者满意率（OR = 0.47, 95%CI:0.19 ～1.17, p=0.10），6个月（ MD = -0.70, 95%CI:-1.39 ～ -0.01, p=0.05）、12个月（MD = -0.50, 95%CI:-1.10 ～ 0.10, p=0.10）和24个月（ MD = -0.20, 95%CI:-0.76 ～ 0.36, p=0.48）VAS评分，JOA评分（OR = 0.35, 95%CI:0.12 ～ 1.00, p=0.05）及随访24个月时AAOS评分（ MD = 4.00, 95%CI: -0.37 ～ 8.37, p=0.07）方面差异无明显统计学意义。
结论：后外侧植骨融合术与360°环周融合相比，可显著缩短手术时间和住院时间，减少术中出血量，提高脊柱融合率，改善患者躯体功能评分和躯体疼痛评分，但不能明显改善患者的Oswestry功能障碍指数和随访6个月、12个月时患者AAOS评分。后外侧植骨融合术可作为更优术式用于临床治疗腰椎滑脱症，临床实践可根据具体情况选择最佳手术方式。 |
| Other Abstract | Background: Posterolateral fusion (PLF) and circumferential fusion (CF) are considered as main operation methods for lumbar spondylolisthesis.
Objective: To evaluate the safety and effective of posterolateral fusion and circumferential fusion in lumbar spondylolisthesis.
Methods: The literature about posterolateral fusion and circumferential fusion in lumbar spondylolisthesis by searching PubMed, the Cochrane Library, Web of Knowledge, Wanfang database, VIP, and CNKI from their inception date to July 2014. Meta-analysis was performed by Revman 5.2 software.
Results: Three RCTs and four retrospective studies were indentified. There were significant difference between PLF and CF for operating time (MD = -71.08, 95%CI: -122.63～-19.54, p=0.007), postoperative hospital stay ( MD = -0.98, 95%CI: -1.85～-0.11, p=0.03), blood loss(MD = -174.66, 95%CI: -304.59～-44.72, p=0.008), fusion rate(OR =0.12, 95%CI: 0.04～0.35, p<0.0001), Physical Function after follow-up 6months(MD =24.87, 95%CI: 22.84～26.90, p<0.00001), 12 months (MD = -1.21, 95%CI: -2.13～-0.29, p=0.01), 24 months( MD = -8.66, 95%CI: -9.54～-7.78, p<0.00001), Physical Pain after follow-up 6months(MD = -5.09, 95%CI: -6.18～-4.00, p<0.00001)、12months (MD = -8.28, 95%CI: -9.24～-7.32, p<0.00001), 24months (MD = -9.91, 95%CI: -10.83～-8.99, p<0.00001), Oswestry disability after follow-up 6months (MD = 8.08, 95%CI:1.23～14.94, p=0.02), 12months(MD = 6.72, 95%CI:6.02～7.42, p<0.00001), 24months( MD = 4.94, 95%CI:4.30～5.57, p<0.00001). However, there were no-significant difference in postoperative complications(OR = 1.16, 95%CI:0.51～2.62, p=0.72), satisfaction rate(OR = 0.47, 95%CI:0.19～1.17, p=0.10), VAS after follow-up 6months ( MD = -0.70, 95%CI:-1.39～-0.01, p=0.05), 12months (MD = -0.50, 95%CI:-1.10～0.10, p=0.10), 24 months (MD = -0.20, 95%CI:-0.76～0.36, p=0.48), JOA (OR = 0.35, 95%CI:0.12～1.00, p=0.05), and AAOS after follow-up 24months ( MD = 4.00, 95%CI: -0.37～8.37, p=0.07).
Conclusions: Compared with Circumferential fusion, Posterolateral fusion is a better choice for Lumbar spondylolisthesis patients. |
