斜外侧入路与后入路椎体融合术治疗腰椎退行性疾病临床疗效的Meta分析

doi:10.3760/cma.j.cn101202-20190524-00172

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (2043 KB) HTML (2 KB)
输出: BibTeX | EndNote (RIS)

摘要目的系统性对比评价斜外侧入路椎间融合术(OLIF)与后入路椎体融合术(PLIF)在治疗腰椎退行性疾病中的临床疗效。方法在中国知网数据库、万方数据库、维普数据库以及PubMed数据库、Cochrane数据库,以“斜外侧椎间融合术”“后入路椎间融合术”和 “oblique lumbar interbody fusion” “oblique lateral interbody fusion” “anterior to psoas” “posterior lumbar interbody fusion”为关键词,计算机检索2010年1月—2019年9月国内外已发表关于OLIF与PLIF对比的病例对照研究或随机对照研究的中英文文献,严格评价文献质量,并提取相关数据,运用RevMan 5.3软件对手术时间、术中出血量、住院时间、疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、椎间隙高度(IDH)、腰椎前凸角(LL),以及手术并发症情况进行Meta分析。结果纳入10篇研究共580例患者,其中经OLIF手术276例,经PLIF手术304例。1项随机对照研究,Cochrane偏倚风险评估为低风险;9项病例对照研究纽卡斯尔-渥太华评分(NOS),其中高质量6项、较高质量3项。Meta分析结果显示,OLIF较PLIF平均手术时间短(WMD=-84.02,95% CI -118.29～-49.74,P＜0.01),平均术中出血量少(WMD=-269.12, 95% CI -319.84～-218.41,P＜0.01),平均住院时间短(WMD=-3.29, 95% CI -4.70～-1.89, P＜0.01),术后IDH恢复更高(WMD=1.11, 95% CI 0.44～1.77, P＜0.01),差异均有统计学意义;而术后ODI(WMD=0.16, 95% CI -1.98～2.30, P＞0.05)、VAS(WMD=0.02, 95% CI -0.52～0.56, P＞0.05)、LL(WMD=0.77, 95% CI -0.40～1.94, P＞0.05)、并发症发生情况(OR=0.91, 95% CI 0.50～1.64, P＞0.05),OLIF和PLIF比较差异均无统计学意义。结论 OLIF与PLIF应用于椎体间融合术均能取得良好的临床疗效,但OLIF手术时间、术中出血量、住院时间更低,术后IDH恢复更高,有更大优势。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	庞瑶
	范云鹏
	李茂强
	侯长举
	朱六龙

关键词 ：脊柱融合术, 腰椎, 斜外侧入路椎体融合术, 后入路椎体融合术, Meta分析

Abstract：Objective To compare the clinical efficacy of oblique lumbar interbody fusion (OLIF) and posterior lumbar interbody fusion (PLIF) in the treatment of lumbar degenerative diseases.Methods Reports were used case-control studies and randomized clinical trials to compare the oblique lumbar interbody fusion with posterior approach interbody fusion were retried from China National Knowledge Internet, Wanfang Data, Weipu Data,PubMed Library, and Cochrane Library, from January 2010 to September 2019. The searched key words were “斜外侧椎间融合术”“后入路椎间融合术”and “oblique lumbar interbody fusion” “oblique lateral interbody fusion” “anterior to psoas” “posterior lumbar interbody fusion”. Methodological quality of the trials was critically assessed. Statistical software Revman 5.3 was used for data analysis, and average operation time, average blood loss, average length of hospital stays, VAS, ODI, IDH, LL, and complications were analysis.Results A total of 580 patients from 10 articles were included, 276 patients using OLIF and 304 patients using PLIF. One randomized controlled trial was low risk evaluated by Cochrane Collaboration risk of bias assessment tool, and six cases controlled trials were high quality and three cases controlled trials were middle high quality evaluated by the Newcastle-Ottawa scale risk of bias assessment tool. The results showed that, when the efficacy of OLIF and PLIF were compared, there was statistical significance in the average operation time(WMD=-84.02, 95% CI -118.29 to -49.74, P＜0.01), average blood loss(WMD=-269.12, 95% CI -319.84 to -218.41, P＜0.01), average length of hospital stays(WMD=-3.29, 95% CI -4.70 to -1.89, P＜0.01), IDH(WMD=1.11, 95% CI 0.44 to 1.77, P＜0.01). However, there was no statistical significance in ODI post operation(WMD=0.16, 95% CI -1.98 to 2.30, P＞0.05), VAS post operation(WMD=0.02, 95% CI -0.52 to 0.56, P＞0.05), LL(WMD=0.77, 95% CI -0.40 to 1.94, P＞0.05), complications(OR=0.91, 95% CI 0.50 to 1.64, P＞0.05).Conclusions Both approaches achieve similar and satisfactory clinical effect in the interbody fusion. However, OLIF has a greater advantage in terms of operation time, blood loss, length of hospital stays, IDH.

Key words： Spinal fusion Lumbar vertebrae Oblique lumbar interbody fusion Posterior lumbar interbody fusion Meta-analysis

收稿日期: 2019-05-24

通讯作者: 朱六龙,Email:zhuliulong@sina.com

引用本文:

庞瑶, 范云鹏, 李茂强, 侯长举, 朱六龙. 斜外侧入路与后入路椎体融合术治疗腰椎退行性疾病临床疗效的Meta分析[J]. 中华解剖与临床杂志, 2020, 25(3): 308-314.
Pang Yao, Fan Yunpeng, Li Maoqiang, Hou Changju, Zhu Liulong. Clinical efficacy of oblique lateral interbody fusion and posterior lumbar interbody fusion for lumbar degenerative diseases:a Meta-analysis. Chinese Journal of Anatomy and Clinics, 2020, 25(3): 308-314.

链接本文:

http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20190524-00172 或 http://www.cjac.com.cn/CN/Y2020/V25/I3/308

[1]	Diebo BG, Shah NV, Boachie-Adjei O, et al. Adult spinal deformity[J]. Lancet, 2019, 394(10193): 160-172. DOI:10.1016/S0140-6736(19)31125-0.
[2]	Mobbs RJ, Phan K, Malham G, et al. Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF[J]. J Spine Surg, 2015, 1(1): 2-18. DOI:10.3978/j.issn.2414-469X.2015.10.05.
[3]	Agarwal N, Faramand A, Alan N, et al. Lateral lumbar interbody fusion in the elderly: a 10-year experience[J]. J Neurosurg Spine, 2018, 29(5): 525-529. DOI:10.3171/2018.3.SPINE171147.
[4]	Tu Z, Li L, Wang B, et al. Stand-alone anterolateral interbody fusion versus extended posterior fusion for symptomatic adjacent-segment degeneration: a retrospective study of 2 years' follow-up[J]. World Neurosurg, 2018, 115: e748-e755. DOI:10.1016/j.wneu.2018.04.165.
[5]	Fujibayashi S, Hynes RA, Otsuki B, et al. Effect of indirect neural decompression through oblique lateral interbody fusion for degenerative lumbar disease[J]. Spine (Phila Pa 1976), 2015, 40(3): E175-E182. DOI:10.1097/BRS.0000000000000703.
[6]	Woods K, Fonseca A, Miller LE. Two-year outcomes from a single surgeon's learning curve experience of oblique lateral interbody fusion without intraoperative neuromonitoring[J]. Cureus, 2017, 9(12): e1980. DOI:10.7759/cureus.1980.
[7]	Li JX, Phan K, Mobbs R. Oblique lumbar interbody fusion: technical aspects, operative outcomes, and complications[J]. World Neurosurg, 2017, 98: 113-123. DOI:10.1016/j.wneu.2016.10.074.
[8]	Higgins JPT, Savovi J, Page MJ, et al. Chapter 8: Assessing risk of bias in a randomized trial[M]//Higgins JPT, Thomas J, Chandler J, et al. Cochrane handbook for systematic reviews of interventions. version 6.0(updated July 2019). Ontario: Cochrane, 2019.
[9]	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses[J]. Eur J Epidemiol, 2010, 25(9): 603-605. DOI:10.1007/s10654-010-9491-z.
[10]	Abbasi H, Abbasi A. Oblique lateral lumbar interbody fusion (OLLIF): technical notes and early results of a single surgeon comparative study[J]. Cureus, 2015, 7(10): e351. DOI:10.7759/cureus.351.
[11]	陈意磊, 朱志海, 王玉康, 等. 斜侧方椎间融合术与经椎间孔椎间融合术在腰椎退变性疾病中前凸矫正效果的对比研究[J]. 中华医学杂志, 2018, 98(25): 1990-1995. DOI:10.3760/cma.j.issn.0376-2491.2018.25.005.Chen YL, Zhu ZH, Wang YK, et al. Effects of oblique lateral interbody fusion and transforaminal lumbar interbody fusion for lordosis correction in degenerative lumbar diseases[J]. Natl Med J China, 2018, 98(25): 1990-1995. DOI:10.3760/cma.j.issn.0376-2491.2018.25.005.
[12]	Jin C, Xie M, He L, et al. Oblique lumbar interbody fusion for adjacent segment disease after posterior lumbar fusion: a case-controlled study[J]. J Orthop Surg Res, 2019,14(1): 216. DOI:10.1186/s13018-019-1276-9.
[13]	Kuang L, Wang B, Lü G. Transforaminal lumbar interbody fusion versus mini-open anterior lumbar interbody fusion with oblique self-anchored stand-alone cages for the treatment of lumbar disc herniation: a retrospective study with 2-year follow-up[J]. Spine (Phila Pa 1976), 2017, 42(21): E1259-E1265. DOI:10.1097/BRS.0000000000002145.
[14]	Lin GX, Akbary K, Kotheeranurak V, et al. Clinical and radiologic outcomes of direct versus indirect decompression with lumbar interbody fusion: a matched-pair comparison analysis[J]. World Neurosurg, 2018,119: e898-e909. DOI:10.1016/j.wneu.2018.08.003.
[15]	Zhu G, Hao Y, Yu L, et al. Comparing stand-alone oblique lumbar interbody fusion with posterior lumbar interbody fusion for revision of rostral adjacent segment disease: a STROBE-compliant study[J]. Medicine (Baltimore), 2018, 97(40): e12680. DOI:10.1097/MD.0000000000012680.
[16]	俞仲翔, 詹红生, 史萌, 等. OLIF与PLIF治疗腰椎融合术后邻近节段退变临床疗效比较[J]. 局解手术学杂志, 2019, 28(9): 701-705. DOI:10.11659/jjssx.04E019009.Yu ZX, Zhan HS, Shi M, et al. Clinical efficacy of oblique lumbar interbody fusion and posterior lumbar interbody fusion for adjacent segment degeneration after lumbar fusion[J]. Journal of Regional Anatomy and Operative Surgery, 2019, (09): 701-705. DOI:10.11659/jjssx.04E019009.
[17]	秦世强, 孙宇庆, 倪文卓, 等. OLIF与TLIF治疗退变性腰椎滑脱合并腰椎管狭窄症的疗效对比[J]. 实用骨科杂志, 2018, 24(07): 628-632. DOI:10.13795/j.cnki.sgkz.2018.07.014.
[18]	刘鑫, 孙兆忠, 李瑞, 等. 腰椎斜外侧椎体间融合术与腰椎后路椎体间融合术治疗腰椎滑脱症创伤反应的对比研究[J].滨州医学院学报, 2017, 40(02): 85-88,93. DOI:10.3969/j.issn.1001-9510.2017.02.002.Liu X, Sun ZZ, Li R, et al. Comparison the postoperative wound reaction of the lumbar spondylolithesis treatment by OLIF and PLIF[J]. Journal of Binzhou Medical University, 2017, 40(02): 85-88, 93. DOI:10.3969/j.issn.1001-9510.2017.02.002.
[19]	Xu DS, Walker CT, Godzik J, et al. Minimally invasive anterior, lateral, and oblique lumbar interbody fusion: a literature review[J]. Ann Transl Med, 2018, 6(6): 104. DOI:10.21037/atm.2018.03.24.
[20]	Wang MY, Tran S, Brusko GD, et al. Less invasive spinal deformity surgery: the impact of the learning curve at tertiary spine care centers[J]. J Neurosurg Spine, 2019: 1-8. DOI:10.3171/2019.6.SPINE19531.
[21]	Patel NP, Birch BD, Dement SE, et al. The mini-open anterolateral approach for degenerative thoracolumbar disease[J]. Clin Neurol Neurosurg, 2010, 112(10): 853-857. DOI:10.1016/j.clineuro.2010.07.008.
[22]	Ohtori S, Mannoji C, Orita S, et al. Mini-open anterior retroperitoneal lumbar interbody fusion: oblique lateral interbody fusion for degenerated lumbar spinal kyphoscoliosis[J]. Asian Spine J, 2015, 9(4): 565-572. DOI:10.4184/asj.2015.9.4.565.
[23]	Wu M, Li J, Zhang M, et al. Efficacy and radiographic analysis of oblique lumbar interbody fusion for degenerative lumbar spondylolisthesis[J]. J Orthop Surg Res, 2019, 14(1): 399. DOI:10.1186/s13018-019-1416-2.
[24]	Abe K, Orita S, Mannoji C, et al. Perioperative complications in 155 patients who underwent oblique lateral interbody fusion surgery: perspectives and indications from a retrospective, multicenter survey[J]. Spine (Phila Pa 1976), 2017, 42(1): 55-62. DOI:10.1097/BRS.0000000000001650.
[25]	Woods KR, Billys JB, Hynes RA. Technical description of oblique lateral interbody fusion at L1-L5 (OLIF25) and at L5-S1 (OLIF51) and evaluation of complication and fusion rates[J]. Spine J, 2017, 17(4): 545-553. DOI:10.1016/j.spinee.2016.10.026.