本文選題：腰椎間盤置換 + 腰椎融合��； 參考：《吉林大學(xué)》2015年碩士論文

【摘要】：背景： 腰椎融合術(shù)一直是治療腰椎間盤退行性疾病的金標(biāo)準(zhǔn)，但是容易加速相鄰節(jié)段的退變，產(chǎn)生新的不穩(wěn)及疼痛，腰椎間盤置換術(shù)被認(rèn)為可以通過保留病變節(jié)段的運(yùn)動(dòng)功能從而避免融合手術(shù)所帶來的不良后果，但對其安全性及有效性是否優(yōu)于融合手術(shù)仍然存在爭議。 目的： 系統(tǒng)評價(jià)腰椎間盤置換術(shù)與腰椎融合術(shù)治療腰椎間盤退變性疾病療效及安全性的差異 方法： 綜合檢索PubMed、EMBASE、BIOSIS、OVID、COCHRANE圖書館、中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫、CNKI等數(shù)據(jù)庫中腰椎間盤置換與腰椎融合治療退變性腰椎病的隨機(jī)對照研究文獻(xiàn),手工檢索中文文獻(xiàn);兩名研究者獨(dú)立進(jìn)行文獻(xiàn)提取、納入文獻(xiàn)的方法學(xué)質(zhì)量評價(jià)、評估偏倚風(fēng)險(xiǎn)及數(shù)據(jù)提取。這些文獻(xiàn)中,實(shí)驗(yàn)組采用椎間盤置換術(shù),而對照組采用腰椎融合術(shù)。采用Revman5.3軟件對所提取數(shù)據(jù)進(jìn)行Meta分析 結(jié)果： 共納入5篇隨機(jī)對照試驗(yàn)，患者共1506例，，其中腰椎融合組490例，腰椎間盤置換組1016例。Meta分析結(jié)果顯示:在平均手術(shù)時(shí)間(MD=㧟44.12，95%CI[㧟94.73，㧟6.49]，P=0.09)、平均術(shù)中失血量(MD=㧟29.41，95%CI[ 173.84,115.01]，P=0.69),、再手術(shù)率(OR=0.76，95%CI[0.50，1.13]，P=0.18)、術(shù)后重返工作狀態(tài)(OR=1.08，95%CI[0.84，1.38]，P=0.56)及術(shù)后鎮(zhèn)痛藥使用情況（OR=0.61，95%CI[0.35，1.06]，P=0.08）等方面，腰椎間盤置換組與腰椎融合組無統(tǒng)計(jì)學(xué)差異。而腰椎間盤置換組在術(shù)后VAS評分(MD=㧟5.65,95%CI[ 9.11，㧟2.19]，P=0.001)、術(shù)后ODI指數(shù)(MD=㧟5.36，95%CI[ 7.90，㧟2.82]， P＜0.0001)、并發(fā)癥發(fā)生率（OR=0.41，95%CI[0.29，0.57]，P＜0.0001)、平均住院時(shí)間(MD=㧟0.82,95%CI[ 1.38,㧟0.26] P=0.004)、患者滿意度（OR=2.08，95%CI[1.54，2.81]，P＜0.00001)及再次選擇同一手術(shù)意愿(OR=2.12，95%CI[1.64，2.75]，P＜0.00001)等方面明顯優(yōu)于腰椎融合組。 結(jié)論： 腰椎間盤置換在近期臨床有效性方面要優(yōu)于腰椎融合，但是遠(yuǎn)期的療效仍需要進(jìn)一步驗(yàn)證。
[Abstract]:Background: Lumbar fusion has always been the gold standard for the treatment of lumbar disc degenerative diseases, but it is easy to accelerate the degeneration of adjacent segments, resulting in new instability and pain. Lumbar disc replacement is considered to be able to avoid the adverse consequences of fusion surgery by preserving the motor function of the diseased segment, but whether its safety and effectiveness is better than that of fusion surgery is still controversial. Objective: Systematic evaluation of the efficacy and safety of lumbar disc replacement and lumbar fusion in the treatment of lumbar disc degeneration Methods: Objective: to search the literature of randomized controlled study of lumbar disc replacement and lumbar fusion for degenerative lumbar spondylopathy in PubMedus EMBASEI Biospectral Library and Chinese Biomedical Literature Database (CNKI), and to search Chinese literature manually. The two researchers independently carried out literature extraction, including methodological quality evaluation, bias risk assessment and data extraction. In the literature, intervertebral disc replacement was performed in the experimental group and lumbar fusion in the control group. Meta Analysis of extracted data with Revman5.3 Software Results: A total of 1506 patients were included in 5 randomized controlled trials, including the lumbar fusion group. 鑵版闂寸洏緗崲緇

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