| ObjectiveThis study aims to use meta-analysis to comprehensively evaluate the clinical efficacy and safety of uni lateral and bilateral pedicle screw internal fixation in the treatment of I or II degree lumbar spondylolisthesis,and provide a reference for clinical treatment.MethodsSearch Pubmed,Embase,The Cochrane Library,China Biomedical Literature Database(CBM),Wanfang Journal Database,China National Knowledge Infrastructure(CNKI)and other databases for unilateral and bilateral pedicle screw internal fixation treatment of I or II lumbar Randomized controlled studies and cohort studies of spondylolisthesis,the search time limit is to build the database until September 2019.The included literature contains at least one of the following indicators:fusion rate of last follow-up,incidence of surgical complications,intraoperative blood loss,duration of surgery,visual simulation score,Japanese Orthopaedic Association score,American Health Survey Scale,etc.,refer to the Cochrane system The evaluation manual 5.0.1 evaluates the quality of the included randomized controlled studies,and uses the Review Manager 5.3 software provided by the Cochrane Library to perform a meta-analysis on the relevant indicators of the included literature.After obtaining the analysis data,discuss the reasons for the results.ResultAfter careful reading and screening,9 studies were included in the analysis,including 6 randomized controlled studies and 3 cohort studies.A total of 560 patients were included,274 in the unilateral fixed group and 286 in the bilateral fixed group.There was no significant difference in general data such as gender and average age between the two groups(P>0.05).Meta analysis results showed:1.Comparison of fusion rate at last follow-up,incidence of surgical complications,intraoperative blood loss,JOA score at last follow-up(more than 1 year after surgery):There was no statistically significant difference between the two groups(fusion rate at last follow-up)P＝0.74,the incidence of surgical complications P＝0.27,the intraoperative blood loss P=0·28,the final follow-up JOA score P＝0.44),the analysis results show that unilateral fixation and bilateral fixation are safe for the treatment of lumbar spondylolisthesis of I and II degrees Sexuality and long-term efficacy are comparable.2.Comparison of unilateral and bilateral groups in the treatment of lumbar spondylolisthesis of Ⅰ and Ⅱ degrees after 1 week of low back pain VAS score:analysis results suggest that the difference in VAS score between the two groups is statistically significant(P<0.00001),which can explain most Patients in the bilateral group recovered faster than those in the unilateral group.3.Comparison of operation duration:The operation time of the unilateral group was shorter than that of the bilateral group,and the difference was statistically significant(P<0.00001).ConclusionBased on the results of this systematic review,this study believes that compared with unilateral pedicle screw fixation,patients with bilateral fixation have a significantly lower VAS score 1 week after surgery,but the fusion rate and incidence of surgical complications at the last follow-up In terms of intraoperative blood loss and JOA score at the last follow-up,there was no significant difference between the two,and the long-term efficacy was basically the same.Unilateral fixation has not been used in the clinic for a long time,and it has not been widely promoted and popularized.The surgical indications,surgical instruments,and surgical proficiency of the surgeons in each study are different.The observed outcome indicators are also different,resulting in various The outcome indicators of the literature are highly heterogeneous,so the conclusions of this study need to be treated with caution,and large-sample,multi-center,high-quality randomized controlled trials still need to be further included to reach more conclusive conclusions. |
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