后路腰椎融合術(shù)與棘突間撐開術(shù)對單節(jié)段腰椎退行性疾病療效的影響的Meta分析
發(fā)布時間：2019-03-07 19:50
【摘要】：[背景及目的]后路腰椎融合術(shù)是治療腰椎退行性疾病的首選方法,然而它的地位目前受到棘突間撐開術(shù)的挑戰(zhàn),本系統(tǒng)綜述旨在評估兩種外科干預(yù)手段(后路腰椎融合術(shù)與棘突間撐開術(shù))在治療單節(jié)段腰椎退行性病變的療效及安全性方面是否具有可比性。[方法]通過使用計算機(jī)系統(tǒng)檢索至2015年3月為止的與比較后路腰椎融合術(shù)和棘突間撐開術(shù)干預(yù)單節(jié)段腰椎退行性病變相關(guān)的文獻(xiàn),其中被納入的數(shù)據(jù)庫包括Medline、 Cochrane、CBM、中國知網(wǎng)、萬方及維普數(shù)據(jù)庫等。收集相關(guān)的臨床對照試驗及隨機(jī)對照試驗后,依據(jù)規(guī)定的納入標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn),予以對文獻(xiàn)逐個行質(zhì)量評估。然后使用RevMan4.2系統(tǒng)評估軟件對可以合并分析的數(shù)據(jù)進(jìn)行Meta分析,最后得出相關(guān)結(jié)論。[結(jié)果]篩選獲取的所有文獻(xiàn),最后共20篇文獻(xiàn)、1292名患者符合納入標(biāo)準(zhǔn)并進(jìn)行了Meta分析。綜合分析結(jié)果表明：棘突間撐開組的手術(shù)時間、術(shù)中出血量均明顯少于后路腰椎融合組,棘突間撐開組的住院時間也少于后路腰椎融合組。短期隨訪結(jié)果在VAS、JOA、ODI(%)評分上,兩組間無明顯差異,故可認(rèn)為棘突間撐開術(shù)在減少手術(shù)時間及術(shù)中出血量的同時可取得與后路腰椎融合術(shù)相類似的臨床療效。在影像學(xué)上,棘突間撐開組可保留部分手術(shù)節(jié)段活動度,減少對鄰近節(jié)段(頭端)活動度的代償性增加,這可能有效避免／減緩鄰近節(jié)段病變的發(fā)生／進(jìn)程。[結(jié)論]棘突間撐開術(shù)創(chuàng)傷小、恢復(fù)快,短期療效與后路腰椎融合術(shù)無明顯差異,但仍需長期臨床結(jié)果的驗證以及納入更多的高質(zhì)量的隨機(jī)對照試驗以做進(jìn)一步評估。
[Abstract]:[background & objective] posterior lumbar fusion is the first choice for the treatment of lumbar degenerative diseases, but its position is currently challenged by interspinous protrusion. The purpose of this review is to evaluate the comparability of the efficacy and safety of two surgical interventions (posterior lumbar fusion and spinous protrusion) in the treatment of single-segment lumbar degenerative diseases. [methods] A computer system was used to search the literatures up to March 2015 related to the comparison of posterior lumbar fusion and interspinous protrusion in the intervention of single-segment lumbar degenerative lesions. The included databases included Medline, Cochrane,CBM,. China knowledge website, Wanfang and Weipu database and so on. After collecting relevant clinical controlled trials and randomized controlled trials, the quality of the literature was evaluated on a case-by-case basis according to the prescribed inclusion criteria and exclusion criteria. Then the RevMan4.2 system evaluation software is used to analyze the data that can be combined and analyzed by Meta. Finally, the relevant conclusions are drawn. [results] A total of 20 articles were selected and 1292 patients met the inclusion criteria and were analyzed by Meta. The results of comprehensive analysis showed that the operative time and the amount of intraoperative bleeding in the interspinous protrusion group were significantly less than those in the posterior lumbar fusion group, and the hospitalization time in the spinous process distraction group was also shorter than that in the posterior lumbar fusion group. There was no significant difference in the VAS,JOA,ODI (%) score between the two groups in short-term follow-up. Therefore, it can be concluded that interspinous protrusion can reduce the time of operation and the amount of bleeding during the operation, and the clinical effect is similar to that of the posterior lumbar fusion. In imaging, partial segment activity can be preserved in the spinous process open group, and the compensatory increase of the adjacent segment (head end) can be reduced, which may effectively avoid / slow down the occurrence / progression of the adjacent segment disease. [conclusion] there is no significant difference in short-term efficacy between interspinous protrusion and posterior lumbar fusion, but long-term clinical results need to be verified and more high-quality randomized controlled trials are included for further evaluation. [conclusion] there is no significant difference in short-term efficacy and posterior lumbar fusion between spinous protrusion and interspinous protrusion.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3
本文編號：2436408
[Abstract]:[background & objective] posterior lumbar fusion is the first choice for the treatment of lumbar degenerative diseases, but its position is currently challenged by interspinous protrusion. The purpose of this review is to evaluate the comparability of the efficacy and safety of two surgical interventions (posterior lumbar fusion and spinous protrusion) in the treatment of single-segment lumbar degenerative diseases. [methods] A computer system was used to search the literatures up to March 2015 related to the comparison of posterior lumbar fusion and interspinous protrusion in the intervention of single-segment lumbar degenerative lesions. The included databases included Medline, Cochrane,CBM,. China knowledge website, Wanfang and Weipu database and so on. After collecting relevant clinical controlled trials and randomized controlled trials, the quality of the literature was evaluated on a case-by-case basis according to the prescribed inclusion criteria and exclusion criteria. Then the RevMan4.2 system evaluation software is used to analyze the data that can be combined and analyzed by Meta. Finally, the relevant conclusions are drawn. [results] A total of 20 articles were selected and 1292 patients met the inclusion criteria and were analyzed by Meta. The results of comprehensive analysis showed that the operative time and the amount of intraoperative bleeding in the interspinous protrusion group were significantly less than those in the posterior lumbar fusion group, and the hospitalization time in the spinous process distraction group was also shorter than that in the posterior lumbar fusion group. There was no significant difference in the VAS,JOA,ODI (%) score between the two groups in short-term follow-up. Therefore, it can be concluded that interspinous protrusion can reduce the time of operation and the amount of bleeding during the operation, and the clinical effect is similar to that of the posterior lumbar fusion. In imaging, partial segment activity can be preserved in the spinous process open group, and the compensatory increase of the adjacent segment (head end) can be reduced, which may effectively avoid / slow down the occurrence / progression of the adjacent segment disease. [conclusion] there is no significant difference in short-term efficacy between interspinous protrusion and posterior lumbar fusion, but long-term clinical results need to be verified and more high-quality randomized controlled trials are included for further evaluation. [conclusion] there is no significant difference in short-term efficacy and posterior lumbar fusion between spinous protrusion and interspinous protrusion.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3
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