So sánh hàn liên thân đốt sống thắt lưng qua lỗ liên hợp bằng phẫu thuật nội soi và phẫu thuật xâm lấn tối thiểu trong điều trị trượt đốt sống thắt lưng: Nghiên cứu phân tích tổng hợp có hệ thống=Endo-tlif versus mis-tlif for lumbar spondylolisthesis: A systematic review and meta

So sánh hàn liên thân đốt sống thắt lưng qua lỗ liên hợp bằng phẫu thuật nội soi và phẫu thuật xâm lấn tối thiểu trong điều trị trượt đốt sống thắt lưng: Nghiên cứu phân tích tổng hợp có hệ thống=Endo-tlif versus mis-tlif for lumbar spondylolisthesis: A systematic review and meta - analysis

0 Người đánh giá. Xếp hạng trung bình 0

Tác giả: Tuấn Anh Bùi, Meng-Huang Wu, Song Hưng Nguyễn, Minh Giám Trịnh, Tsung-Jen Huang, Quang Đình Nam Võ

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.170-179

Bộ sưu tập: Báo, Tạp chí

ID: 243650

Thêm vào giỏ

Spondylolisthesis is the relative displacement of one vertebra on top of another. It usually occurs in the lower part of the spine and is more prevalent among women aged older than 60 years. Neural decompression and intervertebral instrumented fusion were the standard procedure for lumbar spondylolisthesis patients failed to conservative treatment. With the advancements of surgical instruments, minimally invasive surgery (MIS) was applied widely in spinal surgery. However, we still lack of the evidence to confirm which procedure is optimal treatment. Therefore, we conducted a systematic review and meta-analysis to evaluate the clinical outcomes of Endo-TLIF (Endoscope- Transforaminal Lumbar Interbody Fusion) and MIS-TLIF (Minimally Invasive Surgery- Transforaminal Lumbar Interbody Fusion) for lumbar spondylolisthesis treatment. Methods: We collected reports on electronic databases (PubMed, Web of Science, Cochrane Library, Embase, Google Scholar) related to lumbar spondylolisthesis treated by Endo-TLIF or MISTLIF technique and published from 2002 to March 2022. After selecting suitable articles, we used Revman 5.4 software to analyse the statistics and evaluate the bias of included articles. Results: We found 3,052 records through electronic databases and manual seeking. After carefully reviewing, a total of 4 articles were satisfied with the inclusion criteria: 2 comparative studies between UBE-TLIF (Uni lateral Biportal Endoscope-Transforaminal Lumbar Interbody Fusion) and MIS-TLIF, 2 comparative studies between PE-TLIF (Percutaneous Endoscope-Transforaminal Lumbar Interbody Fusion) and MIS-TLIF. Overall, a total of 396 patients with the mean age of 58.2 ± 11.3 years were operated by 3 different surgical techniques. All spondylolisthesis patients had 1 spinal segment fusion through transforaminal approach follow decompression and had 22 ± 8 months of mean post-operated follow-up. Our results showed that Endo-TLIF could give significant difference in blood loss, ambulation time, hospitalization time, 2 weeks and 3 moths post-operative VAS back pain score. However, both procedures had similar results although MIS-TLIF had favour tendency in operation time, 12 months post-operative VAS leg pain score, fusion rate, complication
whereas, Endo-TLIF had favour tendency over 12 months post-operative VAS back pain score, 2 weeks - 3 moths post-operative VAS leg pain score, post-operative ODI. Conclusion: Our results indicated that Endo-TLIF could be a potential method for lumbar spondylolisthesis treatment with significant difference in blood loss, ambulation time, hospitalization time, postoperative 2 weeks and 3 months VAS back pain.Trượt đốt sống là tình trạng di lệch của một đốt sống phía trên so với đốt sống liền kề phía dưới. Tình trạng này thường xảy ra ở vùng thắt lưng thấp và hay gặp ở phụ nữ trên 60 tuổi. Giải ép thần kinh và hàn liên thân đốt sống được xem là phương pháp chuẩn cho bệnh nhân trượt đốt sống mà thất bại với điều trị bảo tồn. Nhờ sự cải tiến của dụng cụ phẫu thuật, phẫu thuật xâm lấn tối thiểu đã được áp dụng rộng rãi trong phẫu thuật cột sống. Tuy nhiên, chúng ta vẫn còn thiếu những bằng chứng để khẳng định phương pháp nào là tối ưu trong điều trị bằng phẫu thuật. Do vậy, chúng tôi tiến hành nghiên cứu phân tích tổng hợp có hệ thống nhằm mục tiêu đánh giá kết quả lâm sàng của phương pháp hàn liên thân đốt sống thắt lưng bằng phẫu thuật nội soi (Endo-TLIF) và phẫu thuật xâm lấn tối thiểu (MIS-TLIF) trong điều trị trượt đốt sống thắt lưng. Phương pháp nghiên cứu: Chúng tôi thu thập các báo cáo được công bố trên kho dữ liệu điện tử (PubMed, Web of Science, Cochrane Library, Embase, Google Scholar) từ năm 2002 đến tháng 3/2022 mà có đề cập đến trượt đốt sống thắt lưng được điều trị bằng phẫu thuật hàn liên thân đốt sống qua lỗ liên hợp bằng phẫu thuật nội soi hoặc phẫu thuật xâm lấn tối thiểu. Sau khi chọn lọc các bài báo phù hợp với tiêu chuẩn đã đưa ra, chúng tôi sử dụng phần mềm Revman 5.4 để phân tích thống kê và đánh giá các sai số từ dữ liệu của các bài báo được chọn lựa. Kết quả: Chúng tôi tìm thấy 3.052 báo cáo thông qua cơ sở dữ liệu điện tử và tìm kiếm thủ công. Sau khi đánh giá cẩn thận, chúng tôi chọn được 4 bài báo thỏa mãn với tiêu chuẩn thu thập: 2 nghiên cứu so sánh hàn liên thân đốt sống qua lỗ liên hợp bằng phẫu thuật nội soi 2 cổng (UBETLIF) với phẫu thuật xâm lấn tối thiểu (MISTLIF), 2 nghiên cứu so sánh hàn liên thân đốt sống qua lỗ liên hợp bằng phẫu thuật nội soi 1 cổng (PE-TLIF) với phẫu thuật xâm lấn tối thiểu (MIS-TLIF). Tổng cộng có 396 bệnh nhân trong 4 bài nghiên cứu với độ tuổi trung bình là 58,2 ± 11,3 và được phẫu thuật bằng 3 kỹ thuật khác nhau. Tất cả bệnh nhân trượt đốt sống thắt lưng trong nhóm nghiên cứu được hàn 1 tầng thông qua lỗ liên hợp sau khi giải ép thần kinh và có thời gian theo dõi sau mổ trung bình là 22 ± 8 tháng. Kết quả nghiên cứu cho thấy: phẫu thuật hàn liên thân đốt sống qua lỗ liên hợp bằng phẫu thuật nội soi (Endo-TLIF) cho kết quả khác biệt có ý nghĩa thống kê về lượng máu mất, thời gian vận động, thời gian nằm viện, chỉ số đau lưng sau mổ 2 tuần và 3 tháng. Tuy nhiên, cả 2 nhóm phẫu thuật đều cho kết quả tương đương nhau với sự khác biệt không có ý nghĩa thống kê mặc dù nhóm MIS-TLIF có xu hướng ưu thế về: thời gian phẫu thuật, chỉ số đau chân sau mổ 12 tháng, tỉ lệ liền xương, biến chứng. Ngược lại, nhóm Endo-TLIF có xu hướng ưu thế về: chỉ số đau lưng sau mổ 12 tháng, chỉ số đau chân sau mổ 2 tuần - 3 tháng, chỉ số giảm chức năng Owestry sau mổ. Kết luận: Kết quả nghiên cứu của chúng tôi cho thấy phẫu thuật hàn liên thân đốt sống qua lỗ liên hợp bằng phẫu thuật nội soi có thể là một phương pháp tiềm năng trong điều trị trượt đốt sống với sự khác biệt có ý nghĩa thống kê về lượng máu mất, thời gian vận động, thời gian nằm viện, chỉ số đau lưng sau mổ 2 tuần và 3 tháng.

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