• 1. 新疆建工醫(yī)院（烏魯木齊 830002） 2. 新疆醫(yī)科大學(xué)附屬腫瘤醫(yī)院（烏魯木齊 830054） 3. 四川大學(xué)華西醫(yī)院中國循證醫(yī)學(xué)中心/ 國際臨床流行病學(xué)網(wǎng)華西研究與培訓(xùn)中心（成都 610041）;

目的 　系統(tǒng)評價單純減壓術(shù)與減壓融合術(shù)兩種手術(shù)方式治療退行性腰椎疾病。
方法 ?、?計算機檢索MEDLINE（from OVID, 1966～2006.4）、EMBASE（1984～2006.4）、CBMdisc（1978～2005.12）、萬方數(shù)據(jù)庫（1981～2006.4）、Cochrane圖書館（2006年第1期）、中文科技期刊數(shù)據(jù)庫（VIP, 1989～2006.4）；② 手工檢索相關(guān)雜志。納入單純減壓和減壓融合兩種手術(shù)方式治療退行性腰椎疾病且隨訪大于2年的隨機和半隨機對照試驗，并進(jìn)行質(zhì)量評價。采用RevMan4.2.8軟件對可以合并分析的指標(biāo)作Meta分析；對不能合并的指標(biāo)用描述性方法分析結(jié)果。
結(jié)果 　有7篇研究符合納入標(biāo)準(zhǔn)，共412例。Meta分析結(jié)果顯示：單純減壓和減壓融合兩種手術(shù)方式治療退行性腰椎疾病在總體療效 [OR 1.83, 95%CI (0.92,3.41)]、疼痛減輕程度 [術(shù)前WMD 0.12, 95%CI (-0.44,0.68); 術(shù)后WMD 0.08, 95%CI (-1.08,1.25)]、術(shù)后腿痛人數(shù) [OR 1.04, 95%CI (0.48,2.25)]、術(shù)后隨訪期二次手術(shù)人數(shù) [OR 0.68, 95%CI (0.30,1.56)] 和圍手術(shù)期并發(fā)癥 [OR1.15, 95%CI (0.51,2.60)] 等方面，其差異均無統(tǒng)計學(xué)意義；但兩組在術(shù)后腰痛的發(fā)生人數(shù)上，差異有統(tǒng)計學(xué)意義 [OR 0.25, 95%CI (0.14,0.46)]。有4個研究比較了手術(shù)時間、術(shù)中失血、術(shù)后腰部使用支具固定時間、住院總費用，結(jié)果表明，單純減壓手術(shù)組少于減壓融合組。有3個研究比較了術(shù)前、術(shù)后椎體過伸過屈位滑移程度、手術(shù)間隙終板成角，術(shù)前術(shù)后椎間隙高度變化與手術(shù)療效的關(guān)系，但不同研究的結(jié)果矛盾。
結(jié)論 　單純減壓和減壓融合兩種手術(shù)方式治療退行性腰椎疾病在總體療效、疼痛減輕程度、術(shù)后腿痛人數(shù)、術(shù)后隨訪期二次手術(shù)人數(shù)和圍手術(shù)期并發(fā)癥等方面，差異無統(tǒng)計學(xué)意義；術(shù)后腰痛的發(fā)生人數(shù)單純減壓組多于減壓融合組。但在手術(shù)時間、出血量、術(shù)后臥床時間、術(shù)后腰部使用支具固定時間及住院總費用方面，單純減壓手術(shù)組則少于減壓融合組。目前尚無足夠的證據(jù)證明X線表現(xiàn)椎體活動度的指標(biāo)對預(yù)后術(shù)后腰痛有指導(dǎo)作用。鑒于本系統(tǒng)評價納入樣本數(shù)較小，文獻(xiàn)總體質(zhì)量也不高，因此，上述結(jié)論還需更多高質(zhì)量、大樣本的隨機對照試驗加以驗證。

引用本文： 黃衛(wèi)民,白靖平,錫林寶勒日,李同相,何祖勝,吳泰相. 單純減壓術(shù)與減壓融合術(shù)比較治療退行性腰椎疾病的系統(tǒng)評價. 中國循證醫(yī)學(xué)雜志, 2006, 06(7): 484-493. doi: 復(fù)制

1. Katz JN, Lipson SJ, Lew RA, et al. Lumbar laminectomy alone or with instrumented or noninstrumented arthrodesis in degenerative lumbar spinal stenosis. Patient selection, costs, and surgical outcomes. Spine, 1997; 22(10): 1123-1131.
2. The Cochrane Collaboration.cochrane reviewers’ Handbook 4.2.3. http://www.cochraneeye.Org/documents/Cochrane%- 20Reviewers’%20Handbook%204.2.3.pdf.
3. The Cochrane Collaboration.RevMan 4.2 User Guide. http://www.cc-ims.net/down load/revman/Documentation- /User%20guide.pdf.
4. Grob D, Humke T, Dvorak J. Degenerative lumbar spinal stenosis. Decompression with and without arthrodesis. J Bone Joint Surg Am, 1995; 77(7): 1036-1041.
5. Rompe JD, Eysel P, Hopf CH, et al. Surgical management of central lumbar spinal stenosis-results with decompressive laminectomy only and with concomitant instrumented fusion with the Cotrel-Dubousset-Instrumentation. Neuro-Orthopedics, 1995; 19(1): 17-31.
6. Vaughan PA, Malcolm BW, Maistrelli GL. Results of L4-L5 Disc Excision Alone Versus Disc Excision and Fusion. Spine, 1988; 13(6): 690-695.
7. Matsudaira K, Yamazaki T, Seichi A, et al. Spinal Stenosis in Grade I Degenerative Lumbar Spondylolisthsis: a Comparative Study of Outcomes Following Laminoplasty and Laminectomy with Instrumented Spinal fusion. J Orthop Sci, 2005; 10(3): 270-276.
8. Takeshima T, Kambara K, Miyata S, et al. Clinical and radiographic evaluation of disc excision for lumbar disc herniation with and without posterolateral fusion. Spine, 2000; 25(4): 450-456.
9. White AH, von Rogov P, Zucherman J, et al. Lumbar Laminectomy for Herniated Disc: A Prospective Controlled Comparison with Internal Fixation Fusion. Spine, 1987; 12(3): 305-307.
10. Herkowitz HN, Kurz LT. Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg Am, 1991; 73(6): 802-808.
11. Harris RI, Macnab I. Structural changes in the lumbar intervertebral discs; their relationship to low back pain and sciatica. J Bone Joint Surg Br, 1954; 36-B(2): 304-322.
12. Kirkaldy-Willis WH, Farfan HF. Instability of the lumbar spine. Clin Orthop Relat Res, 1982; (165): 110-123.
13. Spratt KF, Weinstein JN, Lehmann TR, et al. Efficacy of flexion and extension treatments incorporating braces for low-back pain patients with retrodisplacement, spondylolisthesis, or normal sagittal translation. Spine, 1993; 18(13): 1839-1849.
14. Hanley EN, Matteri RE, Frymoyer JM. Accurate roentgenographic determination of lumbar flexion-extension. Clin Orthop Relat Res, 1976; (115): 145-148.
15. Bjarke Christensen F, Stender Hansen E, Laursen M, et al. Long-Term Functional Outcome of Pedicle Screw Instrumentation as a Support for Posterolateral Spinal Fusion: Randomized Clinical Study With a 5-Year Follow-up. Spine, 2002; 27(12): 1269-1277.
  1. 1. Katz JN, Lipson SJ, Lew RA, et al. Lumbar laminectomy alone or with instrumented or noninstrumented arthrodesis in degenerative lumbar spinal stenosis. Patient selection, costs, and surgical outcomes. Spine, 1997; 22(10): 1123-1131.
  2. 2. The Cochrane Collaboration.cochrane reviewers’ Handbook 4.2.3. http://www.cochraneeye.Org/documents/Cochrane%- 20Reviewers’%20Handbook%204.2.3.pdf.
  3. 3. The Cochrane Collaboration.RevMan 4.2 User Guide. http://www.cc-ims.net/down load/revman/Documentation- /User%20guide.pdf.
  4. 4. Grob D, Humke T, Dvorak J. Degenerative lumbar spinal stenosis. Decompression with and without arthrodesis. J Bone Joint Surg Am, 1995; 77(7): 1036-1041.
  5. 5. Rompe JD, Eysel P, Hopf CH, et al. Surgical management of central lumbar spinal stenosis-results with decompressive laminectomy only and with concomitant instrumented fusion with the Cotrel-Dubousset-Instrumentation. Neuro-Orthopedics, 1995; 19(1): 17-31.
  6. 6. Vaughan PA, Malcolm BW, Maistrelli GL. Results of L4-L5 Disc Excision Alone Versus Disc Excision and Fusion. Spine, 1988; 13(6): 690-695.
  7. 7. Matsudaira K, Yamazaki T, Seichi A, et al. Spinal Stenosis in Grade I Degenerative Lumbar Spondylolisthsis: a Comparative Study of Outcomes Following Laminoplasty and Laminectomy with Instrumented Spinal fusion. J Orthop Sci, 2005; 10(3): 270-276.
  8. 8. Takeshima T, Kambara K, Miyata S, et al. Clinical and radiographic evaluation of disc excision for lumbar disc herniation with and without posterolateral fusion. Spine, 2000; 25(4): 450-456.
  9. 9. White AH, von Rogov P, Zucherman J, et al. Lumbar Laminectomy for Herniated Disc: A Prospective Controlled Comparison with Internal Fixation Fusion. Spine, 1987; 12(3): 305-307.
  10. 10. Herkowitz HN, Kurz LT. Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg Am, 1991; 73(6): 802-808.
  11. 11. Harris RI, Macnab I. Structural changes in the lumbar intervertebral discs; their relationship to low back pain and sciatica. J Bone Joint Surg Br, 1954; 36-B(2): 304-322.
  12. 12. Kirkaldy-Willis WH, Farfan HF. Instability of the lumbar spine. Clin Orthop Relat Res, 1982; (165): 110-123.
  13. 13. Spratt KF, Weinstein JN, Lehmann TR, et al. Efficacy of flexion and extension treatments incorporating braces for low-back pain patients with retrodisplacement, spondylolisthesis, or normal sagittal translation. Spine, 1993; 18(13): 1839-1849.
  14. 14. Hanley EN, Matteri RE, Frymoyer JM. Accurate roentgenographic determination of lumbar flexion-extension. Clin Orthop Relat Res, 1976; (115): 145-148.
  15. 15. Bjarke Christensen F, Stender Hansen E, Laursen M, et al. Long-Term Functional Outcome of Pedicle Screw Instrumentation as a Support for Posterolateral Spinal Fusion: Randomized Clinical Study With a 5-Year Follow-up. Spine, 2002; 27(12): 1269-1277.