单独减压与脊间/间层装置放置用于退行性腰椎病理:系统性审查和元分析
Zach Pennington1, Nikita Lakomkin1, Anthony L Mikula1
1Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota.
World neurosurgery
|March 20, 2024
概括
间脊椎和间层器件 (ISD/ILD) 为患者提供类似的结果,仅用于腰部疾病的减压. 然而,ISD/ILD的成本和重新运行率更高,因此人们对其成本效益提出了质疑.
科学领域:
- 脊柱外科手术 脊柱外科手术
- 整形医疗器械 整形医疗器械
- 卫生经济学 卫生经济学
背景情况:
- 间脊椎器械 (ISD) 和间层器械 (ILD) 是作为退行性腰部疾病的外科替代品销售的.
- 在现有的文献中,仅仅对ISD/ILD和减压进行比较是有限的.
研究的目的:
- 审查和比较ISDs/ILDs与仅用于退行性腰部疾病的减压的成本效益.
- 分析患者报告的结果,并发症和治疗费用.
主要方法:
- 对比ISD/ILD与单独减压的研究的系统性文献综述.
- 随机效应建模用于不同时间点 (<6周至最后一次随访) 的结果分析.
- 结果包括患者报告的结果,术后并发症和总治疗费用.
主要成果:
- ISD/ILD患者在3,6和12个月的腿部疼痛改善较大,但在2年或最后的随访时没有改善.
- 背部疼痛的改善有利于ISD/ILD在1年;奥斯威斯特残疾指数和EuroQoL5维度得分有利于ISD/ILD在大多数时间点.
- 在简单表格36物理组件分数或苏黎世音问卷 (ZCQ) 症状严重程度上没有显著差异. ZCQ的身体功能得分有利于在6个月和12个月单独减压.
- 在ISD/幼儿中,重新手术率 (OR 1.75) 和总护理费用 (SMD 1.19) 较高;并发症率没有显著差异.
结论:
- 患者报告的结果在单独减压和ISD/ILD之间在很大程度上是相似的,差异不符合临床上重要的最低值.
- ISD/ILD与增加的成本和重新运行率有关.
- 目前的证据不支持ISDs/ILDs作为一种具有成本效益的替代方案,仅用于退行性腰部疾病的减压.
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