UBE-LIF与MIS-TLIF治疗腰椎管滑脱的临床疗效与安全性的Meta分析

Meta-Analysis of the Clinical Efficacy and Safety of UBE-LIF and MIS-TLIF in the Treatment of Lumbar Spondylolisthesis

摘要: 目的：通过Meta分析评价单侧双通道内镜腰椎椎体间融合术(Unilateral biportal endoscopic lumbar interbody fusion, UBE-LIF)与微创经椎间孔腰椎椎体间融合术(Minimally invasive transforaminal lumbar interbody fusion, MIS-TLIF)治疗腰椎管滑脱(Lumbar spondylolisthesis, LSP)的临床疗效与安全性。方法：检索PubMed、Cochrane Library、Web of Science、Embase、Medline、CNKI、万方、维普数据库进行了全面搜索关于UBE-LIF和MIS-TLIF治疗LSP的临床预后和并发症等相关研究。提取纳入研究的结局指标数据，包括视觉模拟评分(Visual analogue scale, VAS)、Oswestry功能障碍指数(Oswestry disability index, ODI)、一般评估指标、手术时间、术中出血量和手术并发症。提取数据后通过Review Manager 5.3软件进行Meta分析。结果：共纳入11篇文献，包括1篇随机对照研究、7篇回顾性研究、3篇队列研究，总样本量1034例，其中UBE-LIF组患者502例，MIS-TLIF组患者532例。Meta分析结果显示，MIS-TLIF组手术时间[MD = 23.25, 95% CI (12.41, 34.10), P < 0.0001]方面优于UBE-LIF组，然而在术中失血量[MD = −58.22, 95% CI (−85.49, −30.96), P < 0.00001]方面，UBE-LIF组优于MIS-TILF组；然而在手术并发症[MD = 0.66, 95% CI (0.39, 1.12), P = 0.12]等方面无明显统计学差异；在VAS及ODI评分方面，早中期时期内，UBE组均优于MIS组[MD = −1.09, 95% CI (−1.35, −0.83), P < 0.00001]、[MD = −1.09, 95% CI (−1.35, −0.83), P< 0.00001]、[MD = −2.76, 95% CI (−0.12, −1.36), P = 0.0001]；在晚期恢复中两组未见明显差异[MD = 0.09, 95% CI (−0.22, 0.03), P =0.15]、[MD = −0.64, 95% CI (−1.37, 0.10), P = 0.09]。结论：UBE-LIF和MIS-TLIF均是治疗腰椎管滑脱的微创方式，两者都具有明显的临床疗效和安全性，在手术并发症方面无明显差异。UBE-LIF在术中出血量、术后早期疼痛恢复方面具有优势，然而MIS-TLIF具有手术时间短、学习曲线平缓等优点。

Abstract: Objectives: To evaluate the clinical efficacy and safety of unilateral biportal endoscopic lumbar interbody fusion (UBE-LIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of lumbar spondylolisthesis (LSP) by a Meta-analysis. Methods: A comprehensive search was conducted through PubMed, Cochrane Library, Web of Science, Embase, Medline, CNKI, Wanfang, and VIP databases to retrieve relevant studies on the clinical outcomes and complications of UBE-LIF and MIS-TLIF in the treatment of LSP. Outcome measures extracted from the included studies comprised: visual analogue scale (VAS) scores, Oswestry disability index (ODI), general assessment indicators, operative time, intraoperative blood loss, and surgical complications. Following data extraction, a Meta-analysis was performed using Review Manager 5.3 software. Results: A total of 11 studies were included, comprising 1 randomized controlled trial, 7 retrospective studies, and 3 cohort studies, with a combined sample size of 1034 patients, including 502 patients in the UBE-LIF group and 532 patients in the MIS-TLIF group. The Meta-analysis results demonstrated that the MIS-TLIF group demonstrated shorter operative time compared to the UBE-LIF group [MD = 23.25, 95% CI (12.41, 34.10), P < 0.0001], whereas the UBE-LIF group exhibited significantly less intraoperative blood loss than the MIS-TLIF group [MD = −58.22, 95% CI (−85.49, −30.96), P < 0.00001]. No statistically significant differences were observed in surgical complications between the two groups [MD = 0.66, 95% CI (0.39, 1.12), P = 0.12]. Regarding VAS and ODI scores, the UBE group demonstrated superior outcomes compared to the MIS group during early-to-midterm follow-up periods [MD = − 1.09, 95% CI (−1.35, −0.83), P < 0.00001], [MD = −1.09, 95% CI (−1.35, −0.83), P < 0.00001], [MD = −2.76, 95% CI (−0.12, −1.36), P = 0.0001]. However, no significant differences were observed between the two groups in long-term recovery [MD = 0.09, 95% CI (−0.22, 0.03), P = 0.15], [MD = −0.64, 95% CI (−1.37, 0.10), P = 0.09]. Conclusions: Both UBE-LIF and MIS-TLIF are minimally invasive techniques for treating lumbar spondylolisthesis, demonstrating significant clinical efficacy and safety with no significant differences in surgical complications or postoperative intervertebral disc height. UBE-LIF offers advantages in terms of reduced intraoperative blood loss and better early postoperative pain relief, while MIS-TLIF features shorter operative time and a more gradual learning curve.