文章简介

出版社:Neurosurg Focus

作   者:J. R. Joseph et al.

编   号:10.3171/2015.7.FOCUS15278

年   份:2015    点击量:2919

文章摘要 全文翻译

Object

Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) and lateral lumbar interbody fusion (LLIF) are 2 currently popular techniques for lumbar arthrodesis. Theauthors compare the total risk of each procedure, alongwith other important complication outcomes.

目的

微创经椎间孔椎间融合术(MI-TLIF)和外侧腰椎椎间融合术(LLIF)是目前较为普遍的两种腰椎关节固定术。本文比较了这两种手术的总体风险以及其他重要并发症的评估结果。

 

Methods

This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviewsand Meta-Analyses (PRISMA) guidelines. Relevant studies (up to May 2015) that reported complications of either MI-TLIF or LLIF were identified from a search in the PubMed database. The primary outcome was overall risk of complication per patient. Secondary outcomes included risks of sensory deficits, temporary neurological deficit, permanent neurological deficit, intraoperative complications, medical complications, wound complications, hardware failure, subsidence, and reoperation.

方法

依据系统综述和荟萃分析优先报告的条目(PRISMA)指南进行系统性回顾。通过对PubMed数据库的检索,获取报道MI-TLIF或LLIF并发症的相关研究(截止到2015年5月)。主要观察每名患者的整体并发症风险,其次评估包括感觉丧失、暂时性神经障碍、永久性神经障碍、术中并发症、内科并发症、伤口并发症、内固定失败、下沉和二次手术的风险。

 

Results

Fifty-four studies were included for analysis of MI-TLIF, and 42 studies were included for analysis of LLIF.Overall, there were 9714 patients (5454 in the MI-TLIF group and 4260 in the LLIF group) with 13,230 levels fused (6040 in the MI-TLIF group and 7190 in the LLIF group). A total of 1045 complications in the MI-TLIF group and 1339 complications in the LLIF group were reported. The total complication rate per patient was 19.2% in the MI-TLIF group and 31.4% in the LLIF group (p < 0.0001). The rate of sensory deficits and temporary neurological deficits, and permanent neurological deficits was 20.16%, 2.22%, and 1.01% for MI-TLIF versus 27.08%, 9.40%, and 2.46% for LLIF, respectively (p <0.0001, p < 0.0001, p = 0.002, respectively). Rates ofintraoperative and wound complications were 3.57% and 1.63% for MI-TLIF compared with 1.93% and 0.80% for LLIF, respectively (p = 0.0003 and p = 0.034, respectively). No significant differences were noted for medical complications or reoperation.

结果

本文选择54项研究用以分析MI-TLIF,另筛选42项研究用以分析LLIF。总体来看,本文包括9714名患者(5454 名为MI-TLIF组和4260名为 LLIF组),融合节段涉及13230个(6040个节段为MI-TLIF组和7190个为LLIF组)。据报道,MI-TLIF组共1045 例并发症,LLIF组则为1339例并发症。MI-TLIF组总并发症率是19.2%, LLIF 组是31.4%(p < 0.0001)。MI-TLIF引发感觉丧失、暂时性神经障碍和永久性神经障碍的发生率为20.16%、2.22%和1.01%,而LLIF则为27.08%、9.40%和2.46%(p < 0.0001,p < 0.0001,p = 0.002)。MI-TLIF引起术中和伤口并发症的发生率分别为3.57%和1.63%,相比之下,LLIF的发生率为1.93%和0.80%(p = 0.0003,p = 0.0003)。内科并发症或二次手术的发生率无显著差异。

 

Conclusions

While there was a higher overall complication rate with LLIF, MI-TLIF and LLIF both have acceptable complication profiles. LLIF had higher rates of sensory as well as temporary and permanent neurological symptoms, although rates of intraoperative and wound complications were less than MI-TLIF. Larger, prospective comparative studies are needed to confirm these findings as the current literature is of relative poor quality.

结论

尽管LLIF总并发症发生率较高,但是MI-TLIF和LLIF两者的并发症情况仍可接受。LLIF引起感觉、暂时性和永久性神经症状的发生率较高,但是术中和伤口并发症发生率较MI-TLIF更低。现在文献质量相对较低,因此需要通过大规模前瞻性比较研究进行确认。