目的:综合比较和评估不同腰椎融合技术在腰椎管狭窄症(LSS)患者中的应用效果。
方法:PubMed,Embase,科克伦图书馆,在此网络荟萃分析中,系统搜索了截至2022年12月24日的WebofScience数据库。结果是疼痛(疼痛,腰痛,和腿部疼痛),日本骨科协会(JOA),Oswestry残疾指数(ODI),并发症,再操作,和融合。网络图说明了不同融合技术对结果的直接和间接比较。联赛表显示了任何两种融合技术的比较,基于直接和间接的证据。每种融合技术对LSS的功效按等级概率排序。
结果:共有29项研究纳入2,379名患者。对于痛苦,经皮椎间孔镜下腰椎椎间融合术(Endo-TLIF)最有可能是最好的技术,其次是微创经椎间孔腰椎椎间融合术(MIS-TLIF),极外侧椎间融合(XLIF),和经椎间孔腰椎椎间融合术(TLIF)。经皮内窥镜后路腰椎椎间融合术(Endo-PLIF)最有可能成为治疗下腰痛的最佳技术,依次是MIS-TLIF,微创腰椎后路椎间融合术(MIS-PLIF),XLIF,Endo-TLIF,TLIF,斜腰椎椎间融合术(OLIF),腰椎后路椎间融合术(PLIF),和腰椎后外侧融合(PLF)。MIS-PLIF被认为是治疗腿部疼痛最有效的技术,其次是Endo-TLIF,MIS-TLIF,TLIF,Endo-PLIF,PLIF,OLIF,PLF,XLIF至于JOA得分,Endo-TLIF有最大概率是最好的技术,其次是MIS-TLIF和TLIF。Endo-PLIF最有可能成为治疗并发症的最佳技术,其次是TLIF,MIS-TLIF,Endo-TLIF,OLIF,XLIF
结论:微创融合技术可有效治疗LSS,与传统技术相比。就术后并发症而言,微创技术可能并不逊色。
OBJECTIVE: To comprehensively compare and assess the effects of different lumbar fusion techniques in patients with lumbar spinal stenosis (LSS).
METHODS: PubMed, Embase, Cochrane Library, and Web of Science databases were systematically searched up to December 24, 2022 in this network meta-analysis. Outcomes were pain (pain, low back pain, and leg pain), Japanese Orthopaedic Association (JOA), Oswestry Disability Index (ODI), complications, reoperation, and fusion. Network plots illustrated the direct and indirect comparisons of different fusion techniques for the outcomes. League tables showed the comparisons of any two fusion techniques, based on both direct and indirect evidence. The efficacy of each fusion technique for LSS was ranked by rank probabilities.
RESULTS: Totally 29 studies involving 2,379 patients were eligible. For pain, percutaneous endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) was most likely to be the best technique, followed by minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), extreme lateral interbody fusion (XLIF), and transforaminal lumbar interbody fusion (TLIF). Percutaneous endoscopic posterior lumbar interbody fusion (Endo-PLIF) had the greatest likelihood to be the optimal technique for low back pain, followed sequentially by MIS-TLIF, minimally invasive posterior lumbar interbody fusion (MIS-PLIF), XLIF, Endo-TLIF, TLIF, oblique lumbar interbody fusion (OLIF), posterior lumbar interbody fusion (PLIF), and posterolateral lumbar fusion (PLF). MIS-PLIF was ranked the most effective technique concerning leg pain, followed by Endo-TLIF, MIS-TLIF, TLIF, Endo-PLIF, PLIF, OLIF, PLF, and XLIF. As regards JOA scores, Endo-TLIF had the maximum probability to be the best technique, followed by MIS-TLIF and TLIF. Endo-PLIF had the greatest likelihood to be the optimum technique for complications, followed by TLIF, MIS-TLIF, Endo-TLIF, OLIF, and XLIF.
CONCLUSIONS: Minimally invasive fusion techniques may be effective in the treatment of LSS, compared with traditional techniques. Minimally invasive techniques were likely non-inferior with regards to postoperative complications.