经皮脊柱内镜腰椎间盘切除术与单侧双通道内镜治疗单节段腰椎间盘突出症疗效比较的Meta分析

Percutaneous endoscopic lumbar discectomy versus unilateral biportal endoscopy for single-segment lumbar disc herniation: a systematic review and Meta-analysis

摘要:

目的 比较经皮脊柱内镜腰椎间盘切除术（PELD）与单侧双通道内镜（UBE）治疗单节段腰椎间盘突出症的临床疗效。方法 计算机检索PubMed、Embase、The Cochrane Library、中国生物医学文献数据库、中国知网和万方数据建库至2022年4月发表的，PELD与UBE治疗单节段腰椎间盘突出症疗效比较的临床对照研究，由两名评价员独立提取资料，利用纽卡斯尔-渥太华量表（NOS）对纳入文献进行质量评价。观察治疗后，PELD组与UBE组的主要疗效指标［手术时间、术中出血量、住院时间、并发症、术前和术后各阶段的视觉模拟评分（VAS）、手术前后Oswestry功能障碍指数（ODI）、改良Macnab疗效评定标准优良率、术后椎管横截面积和血清肌酸激酶］，并对符合纳入标准的研究采用RevMan 5.4软件进行Meta分析。结果 纳入2篇前瞻性研究和5篇回顾性研究，分为UBE组（166例）和PELD组（175例）。Meta分析结果显示：PELD组较UBE组手术时间短（MD = 29.89，95%CI：14.07～45.71，P = 0.000），术中出血量较UBE组少（MD = 64.43，95%CI：33.07～95.79，P = 0.000），术后3 d腰痛VAS（MD = 0.72，95%CI：0.47～0.98，P = 0.000）、术后30 d腰痛VAS（MD = 0.27，95%CI：0.18～0.36，P = 0.000）和术后30 d腿痛VAS［MD = 0.29，95%CI：0.20～0.38，P = 0.000］均较UBE组低。两组患者术后住院时间（MD = 1.70，95%CI：-1.33～4.74，P = 0.270）、术后并发症（RR＾ = 1.08，95%CI：0.38～3.07，P = 0.890）、术后6个月内ODI（MD = -0.43，95%CI：-0.88～0.01，P = 0.050）、术后优良率（RR＾ = 0.99，95%CI：0.89～1.09，P = 0.800）、术后椎管横截面积（MD = 24.55，95%CI：-4.59～53.70，P = 0.100）和术后2 d血清肌酸激酶（MD = 115.65，95%CI：-101.15～332.45，P = 0.300）比较，差异均无统计学意义。结论 UBE与PELD术后均能有效缓解腰腿痛，但PELD较UBE手术时间更短，出血量更少，在术后早期腰腿痛恢复方面更具有优势。

Abstract:

Objective To compare the clinical efficacy of percutaneous endoscopic lumbar discectomy (PELD) and unilateral biportal endoscopy (UBE) in treatment of single-segment lumbar disc herniation.Methods All clinical controlled studies of PELD and UBE in the treatment of single-segment lumbar disc herniation published by PubMed, Embase, The Cochrane Library, China Biology Medicine, China National Knowledge Infrastructure and Wanfang Data from the establishment of the database to April 2022 were searched by computer. The data was extracted independently by two evaluators and the quality of the included literatures were evaluated by Newcastle-Ottawa Scale (NOS). After treatment, the main efficacy indexes [operation time, intraoperative hemorrhage, hospital stay, complications, pain visual analogue scale(VAS) before and after operation, Oswestry disability index (ODI) score before and after operation, postoperative excellent or good rate, the cross-sectional area of spinal canal after operation, creatine kinase] of PELD group and UBE group were observed, and Meta-analysis was performed by applying the Review Manager 5.4 software.Results Two prospective studies and five retrospective studies were included. They were divided into UBE group (n = 166) and PELD group (n = 175). Meta analysis showed that compared with UBE, PELD had shorter operation time (MD = 29.89, 95%CI: 14.07 ~ 45.71, P = 0.000), less bleeding (MD = 64.43, 95%CI: 32.07 ~ 95.79, P = 0.000), lower VAS of low back on 3 days after operation (MD = 0.72, 95%CI: 0.47 ~ 0.98, P = 0.000), VAS score of low back pain on 30 days after operation (MD = 0.27, 95%CI: 0.18 ~ 0.36, P = 0.000), VAS of leg pain on 30 days after operation (MD = 0.29, 95%CI: 0.20~0.38, P = 0.000). However, there were no statistical significance between the two groups of the postoperative hospital stay (MD = 1.70, 95%CI: -1.33 ~ 4.74, P = 0.270), complications rate (RR＾ = 1.08, 95%CI: 0.38 ~ 3.07, P = 0.890), ODI within 6 months after operation (MD = -0.43, 95%CI: -0.88 ~ 0.01, P = 0.050), postoperative excellent or good rate (RR＾ = 0.99, 95%CI: 0.89 ~ 1.09, P = 0.800), the cross-sectional area of spinal canal after operation (MD = 24.55, 95%CI: - 4.59 ~ 53.70, P = 0.100) and creatine phosphokinase on two days after operation (MD = 115.65, 95%CI: -101.15 ~ 332.45, P = 0.300).Conclusion UBE and PELD are effective in relieving short-term postoperative pain and promoting functional recovery, but PELD has more advantages in shorter operation time, less bleeding and early recovery of low back and leg pain compared with UBE.