Meta-analysis of posterolateral fusion versus 360° circumferential fusion in lumbar spondylolisthesis

doi:10.3969/j.issn.2095-4344.2014.53.029

Abstract

Abstract:

BACKGROUND: Posterolateral fusion and circumferential fusion are the main operation methods for lumbar spondylolisthesis, and each has their advantages.
OBJECTIVE: To evaluate the safety and validity of posterolateral fusion and 360° circumferential fusion in lumbar spondylolisthesis.
METHODS: A computer-based online retrieval of Cochrane Library, PubMed Database, Web of Knowledge, Chinese Science Citation Database, VIP Database for Chinese Technical Periodicals, China Academic Journal Network Publishing Database, Wanfang database, and Chinese Biomedical Literature Database from their inception date to July 2014. Randomized controlled trials about posterolateral fusion and circumferential fusion in lumbar spondylolisthesis were screened. The involved literatures were analyzed through a Meta-analysis using Revman 5.2 software.
RESULTS AND CONCLUSION: Three randomized controlled trials containing 336 patients were identified, 175 cases in posterolateral fusion group and 161 cases in circumferential fusion group. Meta-analysis results showed that, Oswestry Disability Index in circumferential fusion group was significantly better than that in posterolateral fusion group at follow-up 6 months (MD=8.08, 95%CI: 1.23-14.94, P=0.02), 12 months (MD=6.72, 95%CI: 6.02-7.42, P < 0.000 01), and 24 months (MD=4.94, 95%CI: 4.30-5.57, P<0.000 01). The operating time (MD=-91.15, 95%CI: -133.17 to -49.14, P < 0.000 1) and postoperative hospital stay (MD=-0.98, 95%CI: -1.85 to -0.11, P=0.03) in posterolateral fusion group were significantly better than that in circumferential fusion group. The limb function score and pain score at 6, 12, 24 months of follow-ups in circumferential fusion group were significantly better than that in posterolateral fusion group (P < 0.05). However, there were no significant differences in intraoperative blood loss (MD=-165.51, 95%CI: -375.89 to 44.86, P=0.12), postoperative complications (OR=1.16, 95%CI: 0.51-2.62,P=0.72), and VAS score (MD=0.20, 95%CI: -0.36 to 0.76, P=0.48) between the two groups. Circumferential fusion can significantly reduce Oswestry Disability Index, limb function score and pain score, but prolonged operating time and postoperative hospital stay. The proximal repair scheme should be chosen according to the individual conditions.

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: Meta-analysis, lumbar vertebra, spondylolysis, spinal fusion, randomized controlled trials

CLC Number:

R318

Wang Zhan, Wang Wen-ji. Meta-analysis of posterolateral fusion versus 360° circumferential fusion in lumbar spondylolisthesis[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(53): 8685-8692.

Figures/Tables 4

2.3 手术时间比较的Meta分析纳入的3个随机对照试验均报道了两组手术方式的手术时间(min)[15-17]，各研究间存在统计学异质性(I2=51%，P=0.13)，采用随机效应模型进行Meta分析，结果显示，后外侧植骨融合组与360°环周融合组相比手术时间差异有显著性意义(MD=-91.15， 95%CI：-133.17至-49.14，P < 0.000 1)，后外侧植骨融合组明显优于360°环周融合组。两组手术时间Meta分析结果见图2。 2.4 术中出血量比较的Meta分析纳入的3个随机对照试验均报道了两组手术出血量(mL)[15-17]，各研究间存在统计学异质性(I2=89%，P=0.000 2)，采用随机效应模型进行Meta分析，结果显示，后外侧植骨融合组与360°环周融合组术中出血量差异无显著性意义(MD=-165.51，95%CI：-375.89至44.86，P=0.12)。 2.5 术后住院时间比较的Meta分析纳入的3个随机对照试验均报道了术后住院时间(d)[15-17]，各研究间无统计学异质性(I2=0%，P=0.60)，采用固定模型进行Meta分析，结果显示，后外侧植骨融合组与360°环周融合组在术后住院时间方面差异有显著性意义(MD=-0.98，95%CI：-1.85至-0.11，P=0.03)，后外侧植骨融合组明显优于360°环周融合组。两组术后住院时间的比较见图3。 2.6 术后并发症比较的Meta分析纳入的研究中有2个随机对照试验，报道了术后并发症的发生例数(例)[15-16]，各研究间无统计学异质性(I2=0%，P=0.92)，采用固定模型进行Meta分析，结果显示，后外侧植骨融合组与360°环周融合组在并发症发生率方面差异无显著性意义(OR=1.16，95%CI：0.51至2.62，P=0.72)。 2.7 Oswestry功能障碍指数比较的Meta分析纳入的3个随机对照试验分别报道了两组Oswestry功能障碍指数随访6，12及24个月的结果[15-17]。Meta分析结果显示，2个研究报道了随访6个月后的Oswestry功能障碍指数[15-16]，各研究间存在统计学异质性(I2=91%，P=0.001)，采用随机效应模型进行Meta分析，结果显示，后外侧植骨融合组与360°环周融合组Oswestry功能障碍指数差异有显著性意义(MD=8.08，95%CI：1.23-14.94， P=0.02)，360°环周融合组优于后外侧植骨融合组。有2个研究报道了随访12个月后的Oswestry功能障碍指数[15-16]，各研究间无统计学异质性(I2=0%，P=0.71)，采用固定效应模型进行Meta分析，结果显示，后外侧植骨融合组与360°环周融合组Oswestry功能障碍指数差异有显著性意义(MD= 6.72，95%CI：6.02-7.42，P < 0.000 01)，360°环周融合组优于后外侧植骨融合组。3个研究报道了随访24个月后的Oswestry功能障碍指数[15-17]，各研究间存在统计学异质性(I2=86%，P=0.000 9)，采用随机效应模型进行Meta分析，结果显示，后外侧植骨融合组与360°环周融合组Oswestry功能障碍指数差异有显著性意义(MD=4.94，95%CI：4.30-5.57，P < 0.000 01)，360°环周融合组优于后外侧植骨融合组。随访6，12，24个月Oswestry功能障碍指数的比较见图4-6。 2.8 其他指标的Meta分析纳入的研究中，仅有1个研究报道了随访6，12，24个月后患者目测类比评分[15]，数据分析显示，后外侧植骨融合与360°环周融合组相比，两组术后目测类比评分差异无显著性意义(P > 0.05)。Swan等[15]报道了两组患者术后美国骨科医师协会腰椎功能评分，数据分析结果显示，在随访6个月(MD=17.00，95%CI：12.89-21.11，P < 0.000 01)、12个月(MD=7.00，95%CI：1.78至12.22，P=0.009)，后外侧植骨融合组与360°环周融合组相比差异有显著性意义(P < 0.05)；而在随访24个月(MD=4.00，95%CI：-0.37至8.37，P=0.07)后差异无显著性意义(P > 0.05)。Abdu等[16]报道了躯体功能评分指标，数据分析结果显示，在随访6个月(MD=24.87，95%CI： 22.84-26.90，P < 0.000 01)、12个月(MD=-1.21， 95%CI：-2.13至-0.29，P=0.01)、24个月(MD=-8.66，95%CI：-9.54至-7.78，P < 0.000 01)后，两组患者躯体功能评分差异有显著性意义(P < 0.05)，表明360°环周融合组明显优于后外侧植骨融合组。Abdu等[16]同时也报道了两组躯体疼痛评分指标，数据分析结果显示，在随访6个月(MD=-5.09，95%CI：-6.18至-4.00，P < 0.000 01)、12个月(MD=-8.28，95%CI：-9.24至-7.32，P < 0.000 01)、24个月(MD=-9.91，95%CI： -10.83至-8.99， P < 0.000 01)后，两组患者躯体疼痛评分差异有显著性意义(P < 0.05)，表明360°环周融合组能减轻患者术后疼痛，明显优于后外侧植骨融合组。各评价指标数据分析结果见表2。"

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