Minimally Invasive Lumbar Spinal Fusion Is More Effective Than Open Fusion: A Meta-Analysis.
Minimally Invasive Lumbar Spinal Fusion Is More Effective Than Open Fusion: A Meta-Analysis.
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DOI：
10.3349/ymj.2018.59.4.524
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发表时间：
2018-06
影响因子：
2.4
通讯作者：
Ha JW
中科院分区：
文献类型：
--
作者：
Park Y;Seok SO;Lee SB;Ha JW
评价微创脊柱融合术与开放融合术治疗成人腰椎滑脱或椎关节强硬的疗效。本研究是对两名独立评论员进行全面文献检索后选择的研究中的所有估计值进行的荟萃分析。在745篇文章中，确定了9项前瞻性队列研究。由于研究设计、不一致、不精确和发表偏倚，证据质量被降级。在微创组中观察到更大的奥斯韦斯特里功能障碍指数评分改善[加权平均差（WMD），3.2; 95%置信区间（CI），1.5 - 5.0; p=0.0003]和更低的感染率（比值比，0.3; 95% CI，0.1 - 0.9; p=0.02）（低质量证据）。微创组失血量较少（WMD，269.5 mL; 95% CI，246.2至292.9 mL; p<0.0001），住院时间较短（WMD，1.3天; 95% CI，1.1 - 1.5天，p<0.0001），手术时间更长（WMD，21.0分钟; 95% CI，15.9至26.2分钟; p<0.0001）和辐射暴露时间（WMD，25.4秒; 95% CI，22.0至28.8秒，p<0.0001）比开放组（低质量证据）。两个治疗组之间在疼痛改善、融合率、并发症或后续手术方面没有显著差异（低质量证据）。虽然目前的研究结果受到证据不足的限制，并且缺乏足够的高质量随机对照试验来解决证据上的差距，但我们的结果支持微创腰椎融合术在功能改善、降低感染率、减少失血量和住院时间方面比开放融合术更有效。
To evaluate the efficacy of minimally invasive spinal fusion in comparison to open fusion for adult lumbar spondylolisthesis or spondylosis. The present study was conducted as a meta-analysis of all estimates from studies that were selected after comprehensive literature search by two independent reviewers. Of 745 articles, nine prospective cohort studies were identifed. The quality of evidence was downgraded because of study design, inconsistency, imprecision, and publication bias. Greater Oswestry Disability Index score improvement [weighted mean difference (WMD), 3.2; 95% confdence interval (CI), 1.5 to 5.0; p=0.0003] and a lower infection rate (odds ratio, 0.3; 95% CI, 0.1 to 0.9; p=0.02) were observed in the minimally invasive group (low-quality evidence). The minimally invasive group had less blood loss (WMD, 269.5 mL; 95% CI, 246.2 to 292.9 mL; p<0.0001), a shorter hospital stay (WMD, 1.3 days; 95% CI, 1.1 to 1.5 days, p<0.0001), and longer operation time (WMD, 21.0 minutes; 95% CI, 15.9 to 26.2 minutes; p<0.0001) and radiation exposure time(WMD, 25.4 seconds; 95% CI, 22.0 to 28.8 seconds, p<0.0001) than the open group (low-quality evidence). There were no significant differences in pain improvement, fusion rate, complications, or subsequent surgeries between the two treatment groups (low-quality evidence). Although present findings are limited by insufficient evidence and there is a lack of adequately powered high-quality randomized controlled trials to address this gap in evidence, our results support that minimally invasive lumbar fusion is more effective than open fusion for adult spondylolisthesis and other spondylosis in terms of functional improvement, reducing infection rate, and decreasing blood loss and hospital stay.
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