中国组织工程研究

中国组织工程研究 ›› 2013, Vol. 17 ›› Issue (52): 9041-9048.doi: 10.3969/j.issn.2095-4344.2013.52.017

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

椎间融合器融合和自体骨融合治疗腰椎滑脱效果的Meta分析

买尔旦•买买提，盛伟斌，阿里木•阿布都热西提，郭海龙，邓  强，梁卫东，买买提克里木•吐松江   

  1. 新疆医科大学第一附属医院脊柱外科，新疆维吾尔自治区乌鲁木齐市  830054
  • 修回日期:2013-09-01 出版日期:2013-12-24 发布日期:2013-12-24
  • 通讯作者: 阿里木?阿布都热西提，在读硕士，新疆医科大学第一附属医院脊柱外科，新疆维吾尔自治区乌鲁木齐市 830054 halastan114@163.com
  • 作者简介:买尔旦?买买提★，男，1967年生，新疆维吾尔自治区乌鲁木齐市人，维吾尔族，1999年新疆医科大学毕业，硕士，主任医师，硕士导师，主要从事骨科(脊柱外科)方面的研究。 mardanmmtmx@163.com

Interbody fusion cage and autograft fusion for lumbar spondylolisthesis: A meta-analysis

Mardan•Mamat, Sheng Wei-bin, Alim•Abdurexit, Guo Hai-long, Deng Qiang, Liang Wei-dong, Mamatkirmulla•Tursunjan   

  1. Department of Spinal Surgery, the First Affiliated Hospital of Xinjiang Medical University, Urumqi  830054, Xinjiang Uygur Autonomous Region, China
  • Revised:2013-09-01 Online:2013-12-24 Published:2013-12-24
  • Contact: Alim?Abdurexit, Studying for master’s degree, Department of Spinal Surgery, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China halastan114@163.com
  • About author:Mardan?Mamat★, Master, Chief physician, Master’s supervisor, Department of Spinal Surgery, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China mardanmmtmx@163.com

PDF

538

被引次数

7

摘要：

背景：经过多年的发展，在腰椎滑脱症的手术治疗上椎间植骨融合已经从单纯的后路植骨技术发展到植骨融合加内固定融合技术，并临床上应用最广泛。

目的：对椎间融合器融合和单纯自体骨植骨融合两种不同融合方式治疗腰椎滑脱症的疗效差异进行系统性评价，并为临床提供一定的循证医学证据。
方法：由计算机搜索中国生物医学文献数据库、Pubmed、PQDT(proquest学位论文)、Cochrane 图书馆、Springerlink(医学全文)、MEDLINE和EMBASE等电子数据库(时间为1990年3月至2012年12月)，并手工式检索《中国脊柱脊髓杂志》《中华骨科杂志》《中国矫形外科杂志》《中国修复重建外科杂志》等相关杂志，搜索椎间融合器和/或单纯自体骨移植融合治疗腰椎滑脱疗效比较的临床研究，并按纳入及排除标准获得的合格文献以质量学方法评价。利用RevMan5.1.5(下载于Cachrane Library)Meta分析，比较术中失血量、手术时间、椎间隙高度变化、融合率、优良率、并发症发生率及手术费用等指标。

结果与结论：经过筛选纳入1个前瞻性研究和8个回顾性研究，共585个病例。Meta 分析结果显示：腰椎椎间融合器组融合与自体骨组融合比较，平均手术时间[MD=7.19，95%CI(-34.39，48.77)，P=0.73]、平均术中失血量[MD=21.34，95%CI (-139.56，182.24)，P=0.79]、优良率[OR =1.53，95%CI (0.93，2.53)，P=0.09]、并发症发生率[OR=0.94，95%CI (0.51，1.75)，P=0.85]等方面无统计学差异；而前者术后椎间隙高度丢失小于后者[MD=0.03，95%CI (0.01，0.04)]；前者融合率优于后者[OR =1.87，95%CI (1.08，3.25)，P=0.03]；前者费用高于后者[MD =0.92，95%CI (0.30，1.82)，P=0.004]。椎间融合器融合和自体骨融合治疗腰椎滑脱症都可取得良好的疗效。应用椎间融合器融合可以提高融合率、维持椎间隙高度，但费用高，而在手术时间、术中失血量、优良率及并发症发生率等方面与自体植骨融合效果相同。由于缺乏关于课题前瞻性研究及样本量相对较少的原因，尚需更多及严密设计大样本随机对照研究，实验结论仅具有参考价值。


中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程


全文链接：

关键词: 骨关节植入物, 骨与关节循证医学, 腰椎滑脱, 自体骨椎间融合, 椎间融合器, 骨移植, 内固定, 系统评价

Abstract:

BACKGROUND: The surgical treatment for lumbar spondylolisthesis has developed from posterior lumbar interbody fusion to bone graft fusion and internal fixation, which is widely applied in clinics.
OBJECTIVE: To systemically evaluate the clinical therapeutic efficacy of lumbar interbody fusion between cage and autograft alone for treating lumbar spondylolisthesis, and to provide evidence-based measures for clinical treatment.

METHODS: An online search of China Biological Medicine disk, PubMed, PQDT, Cochrane Library, Springerlink,MEDLINE, and EMBASE databases was performed from March 1990 to December 2012. In addition, we hand-based searched Chinese Journal of Spine and Spinal Cord, Chinese Journal of Orthopaedics, Orthopedic Journal of China, and Chinese Journal of Reparative and Reconstructive Surgery for clinical studies about the comparison of lumbar interbody fusion between cage and alone-autograft for treating lumbar spondylolisthesis. The selected trails were screened out according to the criterion of inclusion and exclusion, and quality was evaluated. RevMan 5.1.5 software (Cachrane Library) was used for Meta analysis. The following indexes were used to compare the results: intraoperative blood loss, operative time, height of vertebral space, fusion rate, excellent and good rate, complication rate and operation fee.

RESULTS AND CONCLUSION: One prospective study and eight case-controlled retrospective studies were included, involving 585 patients. The results of Meta-analysis indicated that compared with autograft fusion, cage fusion showed no differences in operative time [MD=7.19, 95 %CI (-34.39, 48.77), P=0.73], intraoperative blood loss [MD=21.34, 95%CI (-139.56, 182.24), P=0.79], excellent and good rate [OR=1.53, 95%CI (0.93, 2.53), P=0.09], and complication rate [OR=0.94, 95%CI (0.51, 1.75), P=0.85]. The fusion rate was higher in cage fusion compared with autogaft fusion [OR=1.87, 95%CI (1.08, 3.25), P=0.03]. Cage fusion better maintained loss of the height of vertebral space [MD=0.03, 95%CI (0.01, 0.04)] and a higher operation fee [MD=0.92, 95%CI (0.30, 1.82), P=0.004] than autograft fusion. Both cage and autograft fusion are effective for treating lumbar spondylolisthesis. Compared with autograft fusion, cage fusion has the higher fusion rate and higher operation fee, and significantly maintains the height of vertebral space. There was no difference in operative time, blood loss, excellent and good rate, and complication rate. Because of the lack of prospective articles and small sample size, large-sized randomized controlled studies are urgently needed to provide evidence.


中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程


全文链接：

Key words: spondylolysis, lumbar vertebrae, spinal fusion, intervertebral disc, bone transplantation, internal fixators

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