张如骐;雷焦;梁杰;

• 1:三峡大学人民医院宜昌市第一人民医院骨科

摘要(Abstract)：

[目的]采用循证医学Meta分析评价椎旁肌间隙入路腰椎融合术(PLF)与传统后正中入路腰椎融合术(PLIF)对椎旁肌损伤的影响。[方法]计算机检索Pub Med、中国知网、万方和维普数据库,提取有效数据后采用Sata12.0软件分析。评价两组手术时间、术中出血量、术后引流量、术后住院时间、术后并发症。[结果]共纳入12篇文献,928例患者,其中457例经椎旁肌间隙入路行腰椎融合术(PLF组)、471例经传统后正中入路行腰椎融合术(PLIF组)。合并结果显示与PLIF组相比,PLF组术中出血量少(WMD:-2.462 ml,P<0.001),手术时间短(WMD:-0.645 min,P<0.001),术后引流量少(WMD:-2.985 ml,P<0.001),降低术后并发症发生率(OR:1.89,P=0.058),并缩短患者术后住院时间(WMD:-0.93 d,P<0.001)。[结论]椎旁肌间隙入路腰椎融合术是比较安全和有效的,能够减少术中出血量、术后引流量,缩短手术时间和住院时间,降低术后并发症,加速患者康复。

关键词(KeyWords)： 后正中入路腰椎融合术;椎旁肌间隙入路腰椎融合术;椎旁肌损伤;meta分析

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 张如骐;雷焦;梁杰;

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参考文献(References)：

• [1]Schmid SL,Wechsler C,Farshad M,et al.Surgery for lumber disc herniation:analysis of 500 consecutive patients treated in an interdisciplinary spine centre[J].J Clin Neurosci,2016,27(1):40-43.
• [2]刘艳军,袁华平,余相地,等.帕瑞昔布钠预防处理在老年腰椎间盘突出手术术后镇痛中的临床疗效[J].中国老年学杂志,2015,35(3):675-677
• [3]Lurie JD,Henderson ER,Mcdonough CM,et al.Effect of expectations on treatment outcome for lumber intervertebral disc herniation[J].Spine(Phila Pa 1976),2016,41(9):803-809.
• [4]Rasouli MR,Rahimi-Movaghar V,Shokraneh F,et al.Minimally invasive discectomy versus microdiscectomy/open discectomy for symptomatic lumbar disc herniation[J].Cochrane Database Syst Rev,2014(9):CD010328.
• [5]Stephen T.Failed back syndrome[J].Neurologis,2004,10(5):257-264.
• [6]Duggal N,Meadioado I,Parea R.et al.Anterior lumbar interbody fusion for treatment of failed back surgery syndrome:all outcome analysis[J].Neurosury,2004,54(3):636-644.
• [7]Wiltse LL,Bateman JG,Hutchinson RH,et al.The paraspinal sacrospinalis-splitting approach to the lumbar spine[J].J Bone Joint Surg Am,1968,50(5):919-926.
• [8]Tamaki Y,Sakai T,Miyagi R,et al.Intradural lumbar disc herniation after percutaneous endoscopic lumbar discectomy:case report[J].J Neurosurg Spine,2015,23(3):336-339.
• [9]阿忍别克·哈布力汗.后外侧融合与后路椎间融合术治疗轻度腰椎滑脱的疗效对比[D].新疆医科大学,2015.
• [10]石洋,常楚,杨璐,等.后外侧植骨融合与后路椎间植骨融合治疗腰椎退行性病变的疗效评价[J].中国临床医师杂志,2011,5(8):2394-2398.
• [11]顾仕荣,张明.经肌间隙入路或后正中入路行腰椎融合术的效果及其对椎旁肌损伤的影响[J].中国脊柱脊髓杂志,2013,23(4):320-324.
• [12]李旋峰.经肌间隙入路或后正中入路行腰椎融合术的效果及其对椎旁肌损伤的影响[J].现代诊断与治疗,2013,24(15):3408-3409.
• [13]王君,王树德,赵斌,等.不同入路腰椎融合术治疗腰椎疾病的疗效及对肌肉损伤程度的研究[J].检验医学与临床,2016,13(18):2672-2674.
• [14]赵建,刘少,林波,等.经多裂肌间隙椎间融合术治疗腰椎退行性疾病观察[J].实用骨科杂志,2014,20(10):873-876.
• [15]唐志辉,谢天喜,刘晓岚,等.两种融合方法治疗退行性腰椎失稳症105例疗效比较[J].医学临床研究,2007,24(7):1201-1203.
• [16]费志强,徐建广,周蔚,等.三种后路融合方式治疗腰椎滑脱的外科疗效评价[J].脊柱外科杂志,2008,6(4):224-228.
• [17]严盈奇.双侧棘突旁小切口术式在后路单节段腰椎间融合术中的应用价值[D].浙江大学,2011.
• [18]许春财,尹晓明,林飞跃,等.Wiltse入路与传统入路在腰椎融合术中的应用效果比较[J].中国当代医药,2014,21(31):65-70.
• [19]高先政.经椎旁肌间隙入路与传统后正中入路治疗L5/S1腰椎间盘突出症对比研究[D].安徽医科大学,2013.
• [20]彭青强,谢晓勇,李玉茂,等.两种入路腰椎融合术治疗腰椎疾病的疗效比较[J].临床骨科杂志,2016,19(6):678-681.
• [21]李华,陈轶,刘丽君,等.MRI对腰椎间盘脱出髓核游离的诊断价值[J].实用放射学杂志,2008,24(6):813-815.
• [22]付克广,李廷林,任法云,等.腰椎间盘突出症的CT诊断与临床病理分析[J].实用放射学杂志,2003,19(12):1105-1107.
• [23]Lurie JD,Henderson ER,Mcdonough CM,et al.Effect of expectations on treatment outcome for lumbar intervertebral disc herniation[J].Spine(Phila Pa 1976),2016,41(9):803-809.
• [24]Steven CD,Dubois RW,Larequi-Lauber T,et al.Efficacy of lumbar discectomy and percutaneous treatments for lumbar disc herniation[J].Soz Praventivmed,1997,42(6):367-379.
• [25]Annette K,Werner S,Erich K.In vitro stabilizing effect of a transforaminal compared with two posterior lumbar interbody fusion cases[J].Spine,2005,22(30):665-670.
• [26]Harris BM,Hilibrand AS,Savas PE,et al.Transforaminal lumbar interbody fusion:the effect of various instrumentation technique on the flexibility of the lumbar spine[J].Spine,2004,29(4):65-70.
• [27]Holly LT,Schwender JD,Rouben DP,et al.Minimally invasive transforaminal lumbar interbody fusion:indications,technique,and complications[J].Neurosurg Focus,2006,20(3):1-5.
• [28]Karikari IO,Isaacs RE.Minimally invasive transforaminal lumbar interbody fusion:a review of techniques and outcomes[J].Spine,2010,35(26 Suppl):294-301.
• [29]Ames CP,Acosta FL Jr,Chi J,et al.Biomechanical comparison of posterior lumbar interbody fusion and transforaminal lumbar interbody fusion performed at 1 and 2 levels[J].Spine(Phila Pa1976),2005,30(19):562-566.