CAJ | 학술논문

目的系统评价单侧与双侧椎弓根螺钉内固定在短节段腰椎融合手术中的疗效.方法计算机检索1992年1月到2011年11月MEDLINE、EMBASE、Cochrane CENTRAL( Third Quarter 2011)、ScienceDirect、OVID、SpringerLink、中国生物医学文献数据库,手工检索相关杂志.制定纳入和排除标准,筛选出符合纳入标准的文献,评价纳入研究的方法学质量.采用RevMan5.1.1(下载于Cochrane Library)软件进行meta分析.结果经过筛选,7篇研究论著符合纳入标准,共480例,其中单侧固定246例,双侧234例.Meta分析结果显示:单侧与双侧椎弓根螺钉内固定组比较,前者平均手术时间和术中失血量少于后者,差异存在统计学意义(MD=- 24.39,95％CI:- 33.16～15.61,P＜0.01)和(MD=- 118.73,95％ CI:- 143.43～-94.03,P＜0.01)；住院时间、融合率、并发症发生率和优良率等方面两种固定方式之间差异无统计学意义(均P ＞0.05).结论单侧与双侧椎弓根钉固定在腰椎融合于术中均取得了良好的疗效.单侧椎弓根螺钉内固定可以明显减少手术时间、术中出血量和住院费用,在住院时间、融合率、并发症发生率和优良率等方面与双侧固定无明显差异.
목적 계통평개단측여쌍측추궁근라정내고정재단절단요추융합수술중적료효.방법 계산궤검색1992년1월도2011년11월MEDLINE、EMBASE、Cochrane CENTRAL( Third Quarter 2011)、ScienceDirect、OVID、SpringerLink、중국생물의학문헌수거고,수공검색상관잡지.제정납입화배제표준,사선출부합납입표준적문헌,평개납입연구적방법학질량.채용RevMan5.1.1(하재우Cochrane Library)연건진행meta분석.결과 경과사선,7편연구론저부합납입표준,공480례,기중단측고정246례,쌍측234례.Meta분석결과현시:단측여쌍측추궁근라정내고정조비교,전자평균수술시간화술중실혈량소우후자,차이존재통계학의의(MD=- 24.39,95％CI:- 33.16～15.61,P＜0.01)화(MD=- 118.73,95％ CI:- 143.43～-94.03,P＜0.01)；주원시간、융합솔、병발증발생솔화우량솔등방면량충고정방식지간차이무통계학의의(균P ＞0.05).결론 단측여쌍측추궁근정고정재요추융합우술중균취득료량호적료효.단측추궁근라정내고정가이명현감소수술시간、술중출혈량화주원비용,재주원시간、융합솔、병발증발생솔화우량솔등방면여쌍측고정무명현차이.
Objective To evaluate the effectiveness of unilateral versus bilateral pedicle screw fixation in lumbar spinal fusion.Methods Studies on comparison between unilateral and bilateral pediele screw fixation in lumbar spinal fusion were identified from Medline,EMBASE,Cochrane CENTRAL ( Third Quarter 2011 ),ScienceDirect,OVID,SpringerLink and The China Biological Medicine Database,and searched several related journals by hand.The included trials were screened out according to the criterion of inclusion and exclusion.The quality of included trials was evaluated.Data were extracted by two reviewers independently.RevMan 5.1.1 was used for data analysis. Results Seven studies involving 480 patients were included,246 in unilateral group,and 234 in bilateral group.The results of meta-analysis indicated that statistically significant difference were observed between the two fixation procedures in mean operation time (MD=-24.39,95％CI:-33.16 to 15.61,P＜0.01),the amount of bleeding (MD =-118.73,95％CI:- 143.43 to -94.03,P ＜ 0.01 ).There were no difference in inpatient stay,fusion rate,complication rate and excellent and good rate.Conclusions Both unilateral and bilateral pedicle screw fixation are effective in lumbar spinal fusion. To compare with bilateral fixation,unilateral fixation can shorten operation time,reduce amount of bleeding and medical expenses. And there is a similar effect of inpatient stay,fusion rate,complication rate and excellent and good rate.