中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (35): 6491-6495.doi: 10.3969/j.issn.1673-8225.2010.35.008

• 骨与关节循证医学 evidence-based medicine of the bone and joint • 上一篇    下一篇

腰椎间盘置换与腰椎融合治疗腰椎间盘退变性疾病的Meta分析

陈凌云，唐  文，刘志礼，舒  勇   

  1. 南昌大学第一附属医院骨一科，江西省南昌市 330006
  • 出版日期:2010-08-27 发布日期:2010-08-27
  • 通讯作者: 舒勇，硕士生导师，主任医师，南昌大学第一附属医院骨一科，江西省南昌市 330006 shuyong57@163.com
  • 作者简介:陈凌云★，男，1972年生，江西省永修县人，汉族，南昌大学医学院在读硕士，主治医师，主要从事脊柱外科方面的研究。 282777929@qq.com

Lumbar disc replacement versus fusion for treatment of lumbar degenerative disc disease: A Meta-analysis

Chen Ling-yun, Tang Wen, Liu Zhi-li, Shu Yong   

  1. First Department of Orthopaedics, First Affiliated Hospital of Nanchang University, Nanchang  330006, Jiangxi Province, China
  • Online:2010-08-27 Published:2010-08-27
  • Contact: Shu Yong, Master’s super visor, Chief physician, First Department of Orthopaedics, First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China shuyong57@163.com
  • About author:Chen Ling-yun★, Studying for master’s degree, Attending physician, First Department of Orthopaedics, First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China 282777929@qq.com

PDF

327

被引次数

4

摘要：

背景：20世纪60年代提出全新的人工椎间盘置换理念，试图通过人工椎间盘模拟正常人体椎间盘来避免椎间融合的消极影响。然而，人们对于腰椎间盘置换与腰椎融合术治疗腰椎间盘退行性疾病的效果及安全性有较大分歧。
目的：系统评价腰椎间盘置换与腰椎融合术治疗腰椎间盘退变性疾病疗效及安全性的差异。
方法：计算机检索MEDLINE(1966/2009-12)、荷兰医学文摘(EMbase1966/2009-12)、Cochrane 图书馆(2009年第12期)、Cochrane 协作网背痛专业试验数据库、中国生物医学文献数据库(CBM截止2009-12)、CNKI(截止2009-12)等数据库中腰椎间盘置换与椎体间融合治疗退变性腰椎病的随机、半随机对照研究文献，手工检索中文文献；由两名研究者独立进行文献提取和严格的质量评价；这些文献中，实验组采用椎间盘置换，而对照组采用融合术；采用Revman4.2.2软件进行Meta分析。
结果与结论：共纳入7个研究，包括936例患者。Meta分析结果显示，除手术出血量外，手术时间、再手术率椎间盘置换与融合组差异无显著性意义(P > 0.05)；手术并发症、治疗后2年目测类比评分及ODI指数腰椎间盘置换组优于椎体间融合组(P < 0.05)。提示与传统腰椎融合术相比，腰椎间盘置换近期疗效优于腰椎融合术，而安全性无明显差异；远期疗效有待高质量大样本长期随访的随机对照试验进一步验证。

关键词: 系统评价, Meta分析, 腰椎间盘置换, 融合, 安全性

Abstract:

BACKGROUND: The new artificial disc replacement concept was proposed in 1960’s, which attempted to simulate normal human inter-vertebral disc artificial disc to avoid the negative effects of inter-vertebral fusion. However, it remains controversial in term of the efficacy and safety for the two treatments of lumbar degenerative disc disease (DDD).
OBJECTIVE: To assess the effect and the safety of lumbar disc replacement versus fusion for the treatment of DDD.
METHODS: Cochrane Back Group, the Cochrane library (Number 12, 2009), additional electronic database including Medline (1966/2009-12), Embase (1966/2009-12), CBM, CNKI were retrieved for articles of well designed clinical trials related to lumbar disc replacement versus fusion for the treatment of DDD. Chinese Journals were manually searched. Data were extracted and evaluated by two reviewers independently of each other. Among the literature, the test group was treated with artificial disc replacement, while the control group with fusion; The Cochrane Collaboration’s RevMan 4.2.2 software was used for data analyses.
RESULTS AND CONCLUSION: A total of 7 studies were included involving 936 patients. Meta-analysis indicated that no difference was found in mean blood loss mean operation time or re-operation rate between two groups (P > 0.05), but the disc replacement group had lower rate of the complication, better VAS scores and ODI score compared with fusion group (P < 0.05). The disc replacement group show superior clinic efficacy at the immediate postoperative time. However, there is no difference between two groups in safety. More randomized controlled trials with long time and high quality are required for further validation.

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