退行性腰椎滑脱的手术治疗
The Surgical Management of Degenerative Lumbar Spondylolisthesis
A Systematic Review
退行性腰椎滑脱的手术治疗
一项系统性回顾研究
Study Design. Systematic review.
研究设计：系统性回顾
Objective. To identify whether there is an advantage to instrumented or noninstrumented spinal fusion over decompression alone for patients with degenerative lumbar spondylolisthesis.
目的：确定退行性腰椎滑脱患者器械或非器械脊柱融合是否比单纯减压效果更好
Summary of Background Data. The operative management of degenerative spondylolisthesis includes spinal decompression with or without instrumented or noninstrumented spinal fusion. Evidence on the operative management of degenerative spondylolisthesis is still divisive.
研究背景：退行性腰椎滑脱手术方式包括单纯减压、减压器械融合及减压非器械融合，采取何种手术方式依据仍然存在争议。
Methods. Relevant RCT and comparative observational studies between 1966 and June 2005 were identified. Abstracted outcomes included clinical outcome, reoperation rate, and solid fusion status. Analyses were separated into: 1) fusion versus decompression alone and 2) instrumented fusion versus noninstrumented fusion.
方法：对1996年至2005年6月相关螺旋CT及比较性观察研究结果进行鉴定。观察的效果包括临床疗效、再手术率、融合稳定性等，分别对融合与单纯减压、器械融合与非器械融合之间进行比较分析。
Results. Thirteen studies were included. The studies were generally of low methodologic quality. A satisfactory clinical outcome was significantly more likely with fusion than with decompression alone (relative risk, 1.40; 95% confidence interval, 1.04–1.89; P <0.05). The use of adjunctive instrumentation significantly increased the probability of attaining solid fusion (relative risk, 1.37; 95% confidence interval, 1.07–1.75; P <0.05), but no significant improvement in clinical outcome was recorded (relative risk, 1.19; 95% confidence interval, 0.92–1.54). There was a nonsignificant trend toward lower repeat operations with fusion compared with both decompression alone and instrumented fusion.
结果：本研究包含13项研究结果，这些研究采用的方法水平普遍较低。结果发现，采用融合技术的疗效明显优于单纯减压术（相对风险1.40，95％可信区间1.04-1.89，P <0.05）。使用辅助器械融合能比非器械融合更好地获得稳定融合（相对风险1.39，95％可信区间1.07-1.75，P <0.05），但临床疗效无明显区别（相对风险1.19，95％可信区间0.92-1.54）。相比较单纯减压及器械融合而言，非器械融合有降低再次手术率的趋势，但结果无显著意义。
Conclusion. Spinal fusion may lead to a better clinical outcome than decompression alone. No conclusion about the clinical benefit of instrumenting a spinal fusion could be made. However, there is moderate evidence that the use of instrumentation improves the chance of achieving solid fusion.
结论：脊柱融合能比单纯减压获得更好的疗效。目前尚不能得出器械融合更有益于临床疗效的结论，但有一定量的证据表明器械融合能提高获得稳定融合的机会。
[ 本帖最后由 daike_ren 于 2008-6-21 11:02 编辑 ]
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