Meta-分析论文腰椎间盘置换与腰椎融合治疗腰椎间盘退变性疾病的Meta分析.doc

Meta-分析论文：腰椎间盘置换与腰椎融合治疗腰椎间盘退变性疾病的Meta分析 【中文摘要】20世纪60年代提出全新的人工椎间盘置换理念,试图通过人工椎间盘模拟正常人体椎间盘来避免椎间融合的消极影响。然而,至今人们对于腰椎间盘置换与腰椎融合术治疗腰椎间盘退行性疾病的效果及安全性有较大分歧。系统评价腰椎间盘置换与腰椎融合术治疗腰椎间盘退变性疾病疗效及安全性的差异。方法：计算机检索Cochrane图书馆(2009年第12期)、Cochrane协作网专业试验数据库、MEDLINE(1966/2009-12)、荷兰医学文摘(EMbase 1966/2009-12)、中国生物医学文献数据库(CBM截止2009-12)、CNKI(截止2009-12)等数据库中腰椎间盘置换与椎体间融合治疗退变性腰椎病的随机对照研究文献,手工检索中文文献；由两名研究者独立进行文献提取和严格的质量评价；这些文献中,实验组采用椎间盘置换,而对照组采用融合术；采用Revman4.2.2软件进行Meta分析。结果：共纳入7个研究,包括936名患者。Meta分析结果显示,1.手术安全性评估：除手术并发症外,手术出血量、手术时间、再手术率、植入物成功率椎间盘置换与融合组差异无显著性意义(P0.05)；2.手术疗效评估：手术满意率、治疗后2年疼痛评分VAS评分及ODI指数腰椎间盘置换组优于椎体间融合组(P0.05)；通过系统评价腰椎活动范围,提示腰椎间盘置换术后2年能够保留的腰椎活动的生理特性。结论：目前的证据表明,腰椎间盘置换近期疗效优于融合组,而安全性方面,置换组不明显优于融合组。由于部分入选文献数量限制,部分文献质量不高,可能存在各种偏倚,必须对目前这一结论持谨慎态度；期望以后能在高质量大样本及长期随访随机对照试验的基础上,进一步进行系统全面地评价。 【英文摘要】BACKGROUND:The new artificial disc replacement concept was proposed in 1960’s, which attempted to simulate normal human inter-vertebral disc artificial disc to avoid the negative effects of inter-vertebral fusion. However, it remains controversial in term of the efficacy and safety for the two treatments of lumbar degenerative disc disease (DDD).:To assess the effect and the safety of lumbar disc replacement versus fusion for the treatment of degenerative disc disease (DDD)Methods:Cochrane Back Group, the Cochrane library (Number 12,2009), additional electronic database including Medline (1966/2009-12), Embase (1966/2009-12), CBM, CNKI were retrieved for articles of well designed clinical trials related to lumbar disc replacement versus fusion for the treatment of DDD. Chinese Journals were manually searched. Data were extracted and evaluated by two reviewers independently of each other. Among the literature, the test group was treated with artificial disc replacement, while the control group with fusion; The Cochrane Collaboration’s RevMan 4.2.2 software was used for data analyses.RESULTS:7 studies including a total of 936 patients met with th