椎间盘镜与椎间孔镜治疗腰椎间盘突出疗效比较的Meta分析

Percutaneous endoscopic lumbar discectomy versus microendoscopic discectomy for lumbar disc herniation: a Meta-analysis

摘要:

目的??比较椎间盘镜和椎间孔镜治疗腰椎间盘突出症的疗效。方法?通过检索PubMed、Web of Science、Embase、万方和中国知网5个数据库，由两位作者独立筛选出相关文章。运用Cochrane风险因素来评估随机对照试验（RCT）文章质量，运用修改的Newcastle-Ottawa量表进行回顾性文献的质量评估。文章中的数据应用Review Manager 5.3软件进行提取。结果?最后有19篇相关研究被纳入此次Meta分析。椎间孔镜术后短期视觉模拟评分法（VAS）改善明显优于椎间盘镜组（P =0.010），而手术后远期VAS评分变化（P =0.120）、Oswestry功能障碍指数问卷表（ODI）评分变化（P =0.260）、并发症（P =0.100）和残留或复发率（P =0.100）比较，两组差异均无统计学意义。椎间孔镜组出血量更少（P =0.000），切口长度更短（P =0.000），住院天数更少（P =0.000），但是椎间孔镜的手术时间较椎间盘镜组长（P =0.001）。结论?在椎间盘突出的手术治疗方面，经皮椎间孔镜技术无疑是一种更加微创且安全的手术方法。

Abstract:

Objective?To compare the curative effect of percutaneous endoscopic lumbar discectomy (PELD) and microendoscopic discectomy (MED) in lumbar disc herniation.?Methods?A literature search was performed in PubMed, Web of Science, Embase, Wanfang, CNKI. Two authors reviewed all articles individually. The methodological quality of RCTs was assessed by the Cochrane risk of bias tool, and the quality of retrospective studies was evaluated by the modified Newcastle-Ottawa scale. The data was extracted by the Review Manager 5.30. ?Results?A total of 19 articles were brought into this Meta-analysis. The outcomes were divided into primary outcomes and secondary outcomes. Excerpt for the short-term VAS score was lower in PELD group (P = 0.010), other index, including long-term VAS score (P = 0.120), ODI score (P = 0.260), complication (P = 0.100) and recurrence (P = 0.100), didn’t had significant difference in two groups. The blood loss (P = 0.000), hospital stay (P = 0.000) and the length of incision (P = 0.000) were all superiority in PELD group. Whereas the operative time was shorter in MED group (P = 0.001).?Conclusion?PELD was a more minimally invasive and secure technique in lumbar disc herniation.