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[1]葉永勝,張雪飛,吳顯奎,等.減壓融合經皮椎弓根螺釘與開放椎弓根螺釘內固定手術治療腰椎滑脫的系統(tǒng)評價[J].中醫(yī)正骨,2018,30(12):40-43，49.
　YE Yongsheng,ZHANG Xuefei,WU Xiankui,et al.Decompression and fusion combined with percutaneous pedicle screw internal fixation versus open pedicle screw internal fixation for treatment of lumbar spondylolisthesis:a systematic review[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(12):40-43，49.
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減壓融合經皮椎弓根螺釘與開放椎弓根螺釘內固定手術治療腰椎滑脫的系統(tǒng)評價 ()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期數(shù):
2018年12期
頁碼:
40-43，49
欄目:
文獻研究
出版日期:
2018-12-20

文章信息/Info

Title:
Decompression and fusion combined with percutaneous pedicle screw internal fixation versus open pedicle screw internal fixation for treatment of lumbar spondylolisthesis:a systematic review
作者:
葉永勝; 張雪飛; 吳顯奎; 屈錫亮; 莊沙斌; 黃雄飛
(廣東省東莞市中醫(yī)院,廣東 東莞 523005)
Author(s):
YE Yongsheng; ZHANG Xuefei; WU Xiankui; QU Xiliang; ZHUANG Shabin; HUANG Xiongfei
Dongguan Hospital of Traditional Chinese Medicine,Dongguan 523005,Guangdong,China
關鍵詞:
脊椎滑脫;  腰椎;  脊柱融合術;  外科手術; 微創(chuàng)性;  Meta分析;  系統(tǒng)評價
Keywords:
spondylolysis;  lumbar vertebrae;  spinal fusion;  surgical procedures; minimally invasive;  meta-analysis;  systematic review
摘要:
目的:評價減壓融合經皮椎弓根螺釘與開放椎弓根螺釘內固定手術治療腰椎滑脫的療效和安全性。方法:應用計算機檢索PubMed、The Cochrane Library、Embase、中國知網、維普網建庫至2018年5月10日收錄的所有減壓融合經皮椎弓根螺釘內固定手術(經皮組)和減壓融合開放椎弓根螺釘內固定手術(開放組)治療腰椎滑脫的隨機對照研究文獻。由2位研究者獨立篩選文獻、提取資料,依據(jù)Cochrane系統(tǒng)評價手冊(5.3版)進行文獻方法學質量評價后,采用RevMan5.3軟件進行Meta分析。結果:最初共檢索到57篇文獻,經篩選后最終納入9篇文獻,其中7篇為中文文獻、2篇為英文文獻。Meta分析結果顯示,與開放組相比,經皮組的手術時間短[MD=-26.16,95%CI(-42.14,-10.17)]、術中出血量少[MD=-176.66,95%CI(-252.92,-100.39)]; 2組的融合率比較,差異無統(tǒng)計學意義[OR=2.49,95%CI(0.52,11.86)]。8篇文獻描述了并發(fā)癥發(fā)生情況,各文獻中2組的并發(fā)癥均較少,但具體并發(fā)癥不一致,無法進行合并分析。利用并發(fā)癥發(fā)生率進行發(fā)表偏倚分析,漏斗圖顯示分布基本對稱,不存在發(fā)表偏倚。結論:減壓融合經皮椎弓根螺釘內固定手術和減壓融合開放椎弓根螺釘內固定手術均是治療腰椎滑脫的有效方法,均具有較高的安全性; 2種手術方法的融合率相當,但前者的手術時間短、術中出血量少。
Abstract:
Objective:To evaluate the curative effects and safety of combination therapy of decompression,fusion and percutaneous pedicle screw internal fixation versus combination therapy of decompression,fusion and open pedicle screw internal fixation for treatment of lumbar spondylolisthesis.Methods:All the randomized controlled trial(RCT)articles about combination therapy of decompression,fusion and percutaneous pedicle screw internal fixation(group A)versus combination therapy of decompression,fusion and open pedicle screw internal fixation(group B)for treatment of lumbar spondylolisthesis included from database establishing to May 10,2018 were retrieved from PubMed,The Cochrane Library,Embase,China national knowledge internet and VIP Database through computer.The articles were screened and the information was extracted independently by two searchers.The methodological quality of research in the articles was evaluated according to Cochrane systematic evaluation handbook 5.3 and a Meta-analysis was conducted by using RevMan 5.3 software.Results:Fifty-seven articles were searched out in the initial stage.After screening,9 articles(7 Chinese articles and 2 English articles)were included in the final analysis.The results of Meta-analysis demonstrated that the operative time was shorter and the intraoperative blood loss was less in group A compared to group B(MD=-26.16,95%CI(-42.14,-10.17); MD=-176.66,95%CI(-252.92,-100.39)).There was no statistical difference in fusion rate between the 2 groups(OR=2.49,95%CI(0.52,11.86)).The complications were described in 8 articles and they were less in both of the 2 groups.The 2 groups were inconsistent with each other in types of complications,so merged analysis could not be conducted.Publication bias was analyzed according to complication incidence,and the basically symmetrical funnel plot demonstrated that there was no publication bias.Conclusion:Both the combination therapy of decompression,fusion and percutaneous pedicle screw internal fixation and the combination therapy of decompression,fusion and open pedicle screw internal fixation are effective for treating lumbar spondylolisthesis,and both of them have high safety.Moreover,the two therapies are similar to each other in fusion rate,while the former has such advantages as shorter operation time and less intraoperative blood loss.

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備注/Memo

備注/Memo:
基金項目:廣東省東莞市社會科技發(fā)展項目(2018507150021358) 通訊作者:張雪飛 E-mail:[email protected](收稿日期:2018-07-28 本文編輯:李曉樂)
更新日期/Last Update: 2019-05-30