The comparison of instrumented and non-instrumented fusion in the treatment of lumbar spondylolisthesis: a meta-analysis
The comparison of instrumented and non-instrumented fusion in the treatment of lumbar spondylolisthesis: a meta-analysis
复制标题
器械与非器械融合治疗腰椎滑脱症的比较：荟萃分析
作者：
Y. Ye;Dan;Hao Xu
PurposeThis荟萃分析比较是否融合或不使用仪器来治疗这种疾病的不同方面，以患者为中心outcome.MethodsMedline，科克伦，EMBASE，谷歌学术数据库进行了随机对照试验，调查患者严重的慢性下腰痛造成局部腰椎或腰骶椎不稳定造成的峡部裂性脊椎前移或退行性脊椎前移。纳入的随机研究报告了腰痛和功能恢复的定量结局。主要结局是功能改善，次要结局是疼痛改善、患者满意度和融合率。结果与基线相比，内固定患者的功能变化显著低于非内固定患者（合并标准化平均差异;-1.02（95%CI-1.76 to-0.27）; Z-2.67;（P = 0.008））。与基线相比，内固定患者与非内固定患者相比疼痛无显著变化[合并标准化均值差; −0.07（95% CI −1.25至1.12）; Z −0.11;（P = 0.913）]。内固定患者与非内固定患者的满意度无显著差异[合并OR; 2.36（95%CI 0.91-6.11）; Z 1.76;（P = 0.078）]。内固定患者的融合率显著高于非内固定患者[合并OR; 3.28（95% CI 2.22-4.85）; Z 5.96;（P < 0.001）]。结论：这项荟萃分析发现，融合手术与器械的纳入没有提供患者评估的益处。报告了腰椎滑脱患者的结局。证据等级不适用。
PurposeThis meta-analysis compared whether fusion with or without instrumentation to treat this disease differed with respect to patient-centered outcomes.MethodsMedline, Cochrane, EMBASE, Google Scholar data bases were searched for randomized control trials that investigated patients with severe chronic lower back pain resulting from localized lumbar or lumbosacral instability caused by either isthmic spondylolisthesis or degenerative spondylolisthesis. Included randomized studies reported quantitative outcomes for low back pain and functional recovery. The primary outcome was the improvement of function and the secondary outcomes were the improvement of pain, patients’ satisfactory level, and the fusion rate.ResultsA significantly lower function change in patients with instrumented compared with non-instrumented from baseline (pooled standardized mean difference; −1.02 (95 % CI −1.76 to −0.27); Z −2.67; (P = 0.008)]. There was no significant pain change for patients with instrumented compared with that of non-instrumented from baseline [pooled standardized mean difference; −0.07 (95 % CI −1.25 to 1.12); Z −0.11; (P = 0.913)]. There was no significant difference in satisfactory level for patients with instrumented compared with that of non-instrumented [pooled OR; 2.36 (95 % CI 0.91–6.11); Z 1.76; (P = 0.078)]. There was significantly higher fusion rate for patients with instrumented compared with that of non-instrumented [pooled OR; 3.28 (95 % CI 2.22–4.85); Z 5.96; (P < 0.001)].ConclusionsThis meta-analysis found that inclusion of fusion surgery with instrumentation provided no benefit as evaluated by patient-reported outcomes in patients with lumbar spondylolisthesis.Level of evidenceNot applicable.