CAJ | 학술논문

目的系统评价腰椎融合术和腰椎间盘置换术治疗腰椎间盘退变性病患的相关临床结果,为手术方式的选择提供参考依据.方法计算机系统检索PubMed、EMBase、COCHRANE图书馆、中国生物医学文献数据库、CNKI中国知网数据库、维普中文科技期刊数据库等.检索时间从建库到2013年10月.搜集关于比较腰椎融合和腰椎间盘置换治疗腰椎间盘退变性疾病的临床随机对照试验.通过方法学评估后,提取有价值的评价指标数据资料.应用RevMan 5.1软件对数据进行统计分析.结果纳入6篇随机对照试验,共1 658例,其中腰椎融合组543例,腰椎间盘置换组l 115例.Meta分析结果显示:腰椎间盘置换组在视觉模拟量表(VAS)评分(OR=-3.33,95％ CI:-5.94～-0.71,P=0.01)、Oswestry功能障碍指数(ODI)(OR=-5.21,95％CI:-7.51～-2.92,P=0.00)和并发症发生率(OR=0.45,95％ CI:0.21 ～0.95,P=0.04)方面优于腰椎融合组.在手术时间、出血量和二次手术率方面两组差异无统计学意义(P＞0.05).但是在2年和5年亚组分析中发现,两组并发症率差异无统计学意义(P＞0.05).结论腰椎间盘置换在近期临床有效性方面可能要优于腰椎融合,但是远期的疗效需要进一步验证.
목적 계통평개요추융합술화요추간반치환술치료요추간반퇴변성병환적상관림상결과,위수술방식적선택제공삼고의거.방법 계산궤계통검색PubMed、EMBase、COCHRANE도서관、중국생물의학문헌수거고、CNKI중국지망수거고、유보중문과기기간수거고등.검색시간종건고도2013년10월.수집관우비교요추융합화요추간반치환치료요추간반퇴변성질병적림상수궤대조시험.통과방법학평고후,제취유개치적평개지표수거자료.응용RevMan 5.1연건대수거진행통계분석.결과 납입6편수궤대조시험,공1 658례,기중요추융합조543례,요추간반치환조l 115례.Meta분석결과현시:요추간반치환조재시각모의량표(VAS)평분(OR=-3.33,95％ CI:-5.94～-0.71,P=0.01)、Oswestry공능장애지수(ODI)(OR=-5.21,95％CI:-7.51～-2.92,P=0.00)화병발증발생솔(OR=0.45,95％ CI:0.21 ～0.95,P=0.04)방면우우요추융합조.재수술시간、출혈량화이차수술솔방면량조차이무통계학의의(P＞0.05).단시재2년화5년아조분석중발현,량조병발증솔차이무통계학의의(P＞0.05).결론 요추간반치환재근기림상유효성방면가능요우우요추융합,단시원기적료효수요진일보험증.
Objective To compare the related clinical outcomes of total disc replacement (TDR) versus fusion in management of lumbar degenerative disc disease (LDDD)and provid available basis for choice of surgical procedure.Methods Computer systematically researched PubMed,EMBase,COCHRANE Library,CBMWin,CNKI,VIP databases for randomized controlled trials comparing TDR and fusion for LDDD.Data were searched until October 2013.The available statistical data was extracted after methodological assessment.The statistical soft RevMan 5.1 was used to analyze the results.Results Total 1 658 cases of patients in 6 studies were conducted,including 543 cases of fusion and 1 115 cases of TDR.The results of Meta-analysis showed that TDR was superior to fusion in term of visual analogue scale (VAS) (OR =-3.33,95％ CI:-5.94--0.71,P =0.01),Owestry disability index (ODI) (OR =-5.21,95％ CI:-7.51--2.92,P =0.00),complication (OR =0.45,95％ CI:0.21-0.95,P =0.04).There were no statistically difference regarding operating time,blood loss and reoperation (P ＞ 0.05).However,there was no difference in term of complication in two-year and five-year sub-analysis.Conclusion Regardless TDR may be more effective comparable to lumbar fusion at the immediate postoperative time,vigorous evidence is still requisite to certify the result in long-term follow-up.