单侧双通道内镜下腰椎椎间融合术与微创经椎间孔入路腰椎椎间融合术治疗腰椎管狭窄症疗效比较的Meta分析

Meta-Analysis of Comparing the Outcomes of Unilateral Double-Channel Endoscopic Lumbar Interbody Fusion versus Minimally Invasive Transforaminal Lumbar Interbody Fusion for the Treatment of Lumbar Spinal Stenosis

摘要: 目的：在于比较单侧双通道内镜下腰椎椎间融合术(ULIF)与微创经椎间孔入路腰椎椎间融合术(MIS-TLIF)治疗腰椎管狭窄症(LSS)的临床疗效。方法：使用计算机对中外数据库PubMed、Medline、中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方数据(WANFANG)、维普资讯(VIP)进行检索，选取2010年1月至2023年12月发表的，ULIF与MIS-TLIF治疗腰椎管狭窄症疗效比较的临床对照研究，由两名评价员独立提取资料，利用纽卡斯尔–渥太华量表(NOS)对纳入文献质量进行评价。观察治疗前后，ULIF组与MIS-TLIF组的主要疗效指标(手术时间、术中失血量、术后住院天数、手术节段椎间隙高度、血清肌酸激酶(CK)、血清C反应蛋白(CRP)、Bridewell椎间融合率、腰痛VAS评分、腿痛VAS评分、Oswestry功能障碍指数(ODI)、术后优良率、术后并发症)并对符合纳入标准的研究采用RevMan 5.4软件进行Meta分析。结果：共纳入1篇前瞻性研究和8篇回顾性研究，分为ULIF组(327例)和MIS-TLIF组(338例)。Meta分析结果显示：与ULIF组相比，MIS-TLIF组手术时间更短，术后第1天MIS-TLIF组CK较ULIF组高。ULIF组住院时间更短，术前椎间隙高度ULIF组较低，ULIF组术后第3个月腰痛VAS评分较低，ULIF组术后第1个月ODI较低。其余各时间点两组术中失血量、腰腿痛VAS评分、ODI、CK、CRP、椎间隙高度、椎间融合率、术后优良率、术后并发症比较均无统计学意义。结论：MIS-TLIF较ULIF手术时间更短，但ULIF较MIS-TLIF术中对组织破坏更少，术后住院时间更短，短期内腰腿功能恢复更具优势。

Abstract: Objective: To compare the clinical efficacy of unilateral biportal endoscopic lumbar interbody fusion (ULIF) versus minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of lumbar spinal stenosis (LSS). Methods: A computer-based search was conducted on domestic and international databases including PubMed, Medline, Chinese Biomedical Literature Database (CBM), CNKI, WANFANG, and VIP. Clinical controlled studies published between January 2010 and December 2023 comparing the efficacy of ULIF and MIS-TLIF for LSS were selected. Two evaluators independently extracted data and assessed the quality of included literature using the Newcastle-Ottawa Scale (NOS). The primary efficacy indicators (surgical time, intraoperative blood loss, postoperative hospital stay, intervertebral disc height, serum creatine kinase (CK), serum C-reactive protein (CRP), Bridewell interbody fusion rate, VAS scores for back pain and leg pain, Oswestry Disability Index (ODI), postoperative success rate, and postoperative complications) were observed before and after treatment in both groups. A Meta-analysis was performed using RevMan 5.4 software for studies that met the inclusion criteria. Results: A total of 1 prospective study and 8 retrospective studies were included, comprising 327 cases in the ULIF group and 338 cases in the MIS-TLIF group. Meta-analysis results indicated that compared to the ULIF group, the MIS-TLIF group had shorter surgical times and higher CK levels on the first postoperative day. The ULIF group had shorter hospital stays, lower preoperative disc heights, lower VAS scores for back pain at 3 months postoperatively, and lower ODI scores at 1 month postoperatively. No statistically significant differences were found between the two groups for intraoperative blood loss, VAS scores for back and leg pain, ODI, CK, CRP, intervertebral disc height, fusion rates, postoperative success rates, or postoperative complications. Conclusion: MIS-TLIF has a shorter surgical time compared to ULIF, but ULIF results in less tissue damage, shorter hospital stays, and greater advantages in short-term recovery of lumbar and leg function.