腰椎滑脫患者接受開放式腰椎經椎孔融合手術(OPEN-TLIF)與微創腰椎經椎孔融合手術(MIS-TLIF)之成本效果分析：系統性回顧與統合分析

研究目的腰椎滑脫患者以開放式經腰椎經椎孔融合手術(OPEN-TLIF)與微創腰椎經椎孔融合手術(MIS-TLIF)治療的優缺點尚無法有一致性的認定，本研究旨在利用系統性文獻回顧與統合分析探討前述2種手術之成本、效果及成本效果分析，以期能獲得一致性的結論。研究方法本研究方法使用系統性文獻回顧與統合分析，利用關鍵字搜尋6個資料庫，再依據PRISMA四階段和檢核表納入11篇文獻，OPEN-TLIF與MIS-TLIF之成本、效果差異使用CMA-Ⅲ統合分析軟體進行分析，包含森林圖、漏斗圖及異質性檢定；二者之遞增成本效果比(Incremental Cost Effectiveness Ratio)則以敘述性統計方式來呈現。研究結果經統合分析結果，MIS-TLIF直接成本較OPEN-TLIF低(16,329.58美元 vs. 18,782.08美元，P<.0005)。在效果部分，MIS-TLIF比OPEN-TLIF手術時間短(169.2分鐘 vs. 195.3分鐘，P<.0005)，MIS-TLIF比OPEN-TLIF失血量少(142.3ml vs. 407.6ml，P<.0005)，MIS-TLIF比OPEN-TLIF住院天數短(4.2天 vs. 5.8天，P<.0005)，併發症發生的比例，MIS-TLIF與OPEN-TLIF無顯著差異(15.6% vs. 18.4%，P=.408)。成本效果經敘述性統計顯示，MIS-TLIF與OPEN-TLIF皆具成本效果。結論與建議 OPEN-TLIF及MIS-TLIF皆具成本效果且併發症無顯著差異，但MIS-TLIF直接成本較低、手術時間較短、失血量較少、住院天數較短，故選擇實施MIS-TLIF較佳。雖然MIS-TLIF好處較多，但有少部分病患(複雜個案及復發個案)需謹慎評估是否適用，若經醫師的評估、檢查及臨床實務考量下，建議應採取OPEN-TLIF手術的話，仍應遵照醫師建議實施。

關鍵字

腰椎滑脫；開放式腰椎經椎孔融合手術；微創腰椎經椎孔融合手術；成本效果分析；統合分析

並列摘要

Objective The advantages and disadvantages of Minimally Invasive Versus Open Transforaminal Lumbar Interbody Fusion in patients with lumbar spondylolisthesis cannot be consistently determined. Systematic review and Meta-analysis explored the cost, effectiveness and cost-effectiveness analysis of the above two types of surgery, in order to obtain consistent conclusions. Methods This research method uses Systematic Review and Meta-Analysis, uses keywords to search 6 databases, and then includes 11 articles according to PRISMA four-stage and checklist. The cost and effectiveness difference between OPEN-TLIF and MIS-TLIF use CMA-III integrated analysis software is analyzed, including forest maps, funnel plots, and heterogeneity tests; the Incremental Cost Effectiveness Ratio is presented in descriptive statistics. Results As a result of the Meta-analysis, the direct cost of MIS-TLIF is lower than the direct cost of OPEN-TLIF ($16,329.58 vs. $18,782.08, P<.0005). About the effectiveness, the operative time of MIS-TLIF was shorter than OPEN-TLIF (169.2 minutes vs. 195.3 minutes, P < .0005). The blood loss of MIS-TLIF was less than OPEN-TLIF (142.3 ml vs. 407.6 ml, P < .0005). The hospitalization of MIS-TLIF was shorter than OPEN-TLIF (4.2 days vs. 5.8 days, P < .0005), and the complication rate was not significantly different between MIS-TLIF and OPEN-TLIF (15.6% vs. 18.4%, P=.408). Cost-effectiveness According to descriptive statistics, both MIS-TLIF and OPEN-TLIF are cost-effective. Conclusions Open and minimally invasive surgery are both cost-effective and there are no significant differences in complications, but minimally invasive surgery is less costly, shorter operative time, less blood loss, and shorter hospitalization, so it is better to choose minimally invasive surgery. Although the benefits of minimally invasive surgery are higher, but complex and recurrence cases need to be carefully evaluated for applicability. After the examination and clinical considerations, it is recommended that OPEN-TLIF surgery should be performed, it should still be implemented according to the physician’s advice.