| Objective:The article has carried on a systematic review and quantitative meta-analysis of the literature with regard to the methods, cage fusion and intervertebral bone graft fusion, for the treatment of lumbar degenerative disease. In addition to it, the article supplies a comprehensive evaluation and comparision of the clinical curative effect and security between interbody fusion cage and intervertebral bone graft. Methods:Mainly computer retrieval utilized, mass of data has been applied to the research, including kinds of literature and Related registration research projects. The former is about the clinical efficacy Cage fusion and Pure intervertebral bone graft fusion by the end of July 17 th 2015 on Pubmed 、 Embase 、 Cochrane Database 、 Wanfang Database 、 China National Knowledge Infrastructure and so on. The latter has been searched on The WHO international clinical trial register platform. Prospective and retrospective study thus has been selected to compare the clinical curative effect and security between cage fusion and intervertebral bone graft. We take cage as the experimental group, bone graft as control group; two independent researchers have extracted the Literature and carried out strict quality evaluation; the clinical observation index adopted are: The operation time、Intraoperative blood loss 、 Preoperative and postoperative JOA scores 、 Preoperative and postoperative JOA score period、Preoperative and postoperative ODI score、Preoperative and postoperative VAS score 、Preoperative and postoperative intervertebral disc height、Preoperative and postoperative intervertebral height difference,The last follow-up fusion rate、The postoperative complications; Using Revman5.3 software in Meta analysis,mapping tree graph and the funnel. For continuity index, assemble the mean and standard deviation to the weighted mean differences, with 95% confidence interval(CI); Discontinuity index, using the odds ratio(odds thewire, OR) OR relative risk(relative risk, RR), with a 95% confidence interval(CI) to evaluate the results of dichotomy. Using Q statistical test and the heterogeneity of I2 test results for inspection; Using cochrane bias risk assessment tool to evaluate the article one by one, mapping bias risk(figure 25) and risk of bias summary figure(figure 26), and a random number of research methods(MINORS) bias evaluation table to evaluate. Using GRADEpro to evaluate quality of evidence. using descriptive methods to analyze the results of cannot-merge indicators. Results:The number of study conformed to the inclusion criteria is 32,including 3 pieces of all study II class evidence, 29 pieces of all study III class evidence, with a total of 2138 patients, the MINORS scale evaluation scored an average of 15.81. Meta analysis showed : Cage compared with bone graft group preoperative VAS score analysis(WMD = 0.08, 95% CI(0.39, 0.23), P = 0.63), Cage compared with bone graft group postoperative the last follow-up time VAS score analysis(WMD = 0.22, 95% CI(2.49, 2.93), P = 0.87), Cage compared with bone graft group analysis of preoperative JOA score(WMD = 0.29, 95% CI(0.31, 0.89), P = 0.35), Cage compared with bone graft group postoperative JOA score analysis, the last follow-up(WMD = 0.08, 95% CI(1.07, 1.23), P = 0.89), the rate of Cage compared with bone graft group,(RR = 0.85, 95% CI(0.64, 1.13], P = 0.26), the last follow-up fusion Cage compared with bone graft group rate,( RR=0.64,95%CI[0.48,0.84],P=0.001),Cage group compared with bone graft group operation time,(WMD = 14.69, 95% CI(8.24, 37.62), P = 0.0.21), Cage group compared with bleeding amount of bone graft group,(WMD = 21.96, 95% CI(67.44, 111.36), P = 0.63), Cage group compared with bleeding amount of bone graft group,(WMD = 1.31, 95% CI(0.78, 1.85], P < 0.00001), Cage compared with bone graft group of intervertebral height difference,(WMD = 1.61, 95% CI(0.62, 2.60], P = 0.001), Cage compared with bone graft group preoperative ODI score analysis(WMD = 0.99, 95% CI(0.48, 2.46), P = 0.. 19), Cage compared with bone graft group at the end of the postoperative follow-up time ODI score analysis(WMD = 2.52, 95% CI(2.26, 7.29), P = 0.30), Cage compared with bone graft group before operation, abnormal segmental mobility(WMD = 0.37,95% CI(1.96, 1.22), Cage compared with bone graft group at the end of the postoperative follow-up time operation, abnormal segmental mobility(WMD = 0.05, 95% CI(1.1, 0.02), P = 0.16), Nonrandomized study method of index scale(MINORS) scored an average of 15.81. Conclusion:The current evidence shows that, in the application of posterior lumbar bone graft fusion, cage fusion has better convergence rate, Good JOA period ratio is also relatively higher than pure bone graft fusion, there were no obvious differences in Complications. Due to some reasons,including parts of the inferior-quality literatures、Quantitative restrictions of articles、mostly short to medium term follow-up,some comparisons of this meta-analysis exist obvious heterogeneity, as well as the possibility of a variety of bias, at present more cautious attitude should be paid to this conclusion; it is hoped that more comprehensive and systematic evaluation can be carried out to verify it on the basis ofrandomized controlled trials with high quality 、 large samples 、Long-term follow-up。... |
PDF Full Text Request