微创椎间盘切除与标准切除术治疗腰椎间盘突出症的Meta分析  

Meta-analysis of microdiscectomy versus standard discectomy in the treatment of Lumbar Disc Herniation

作　　者：臧加成[1] 马信龙[1,2] 马剑雄[1] 王涛[1] 田鹏[1] 韩超[1] 

机构地区：[1]天津医科大学总医院骨科,天津市300052 [2]天津市天津骨科医院,天津市300211

出　　处：《中国脊柱脊髓杂志》2010年第11期938-944,共7页Chinese Journal of Spine and Spinal Cord

基　　金：天津市科委应用基础与前沿技术研究计划重点项目(09JCZDJC19600);天津市卫生局科技基金(09kR08);天津市卫生局科技基金(06kz48)

摘　　要：目的:系统评价微创椎间盘切除术与标准开放椎间盘切除两种手术方式治疗腰椎间盘突出症的疗效。方法:计算机检索MEDLINE(1977年～2010年5月)、EMBASE(1977年～2010年5月)、Cochrane ControlledClinical Trials Register(2010第1期)、Current Controlled Trials(2003年5月～2010年5月)、中国生物医学文献数据库(1984年～2010年5月),手工检索相关杂志。搜集国内外关于微创椎间盘切除术与标准开放椎间盘切除术治疗腰椎间盘突出症疗效比较的随机对照试验(RCT)。制定入选和剔除标准,筛选出符合纳入标准的文献,评价纳入研究的方法学质量。利用RevMan5.0(Cochrane Library)进行Meta分析。结果:共有9篇研究符合纳入标准,共1109例患者,微创椎间盘切除术654例,标准开放椎间盘切除455例。Meta分析结果显示:微创椎间盘切除术与标准开放椎间盘切除术比较,前者平均手术时间长于后者(P<0.05),术中出血量少于后者(P<0.01),术后腰痛VAS评分优于后者(P<0.01);在住院时间、并发症发生率、二次手术率、术后腿痛VAS评分及术后JOA评分,两者差异无统计学意义。结论:微创椎间盘切除术与标准开放椎间盘切除术治疗腰椎间盘突出症都取得了良好的疗效,在术中出血量、术后腰痛改善方面微创手术优于后者,但手术时间长于后者,总体疗效并无显著差异。Objective：To assess the effectiveness of microdiscectomy versus standard discectomy for lumbar disc herniation.Method：A computer-based online search of Medline （1977 to May,2010）,EMBASE （1977 to May,2010）,Cochrane Controlled Clinical Trials Register（1th Quarter 2010）,Current Controlled Trials（2003 to May,2010）.The China Biological Medicine Database （1984 to May,2010）,and several hand searched related journals were performed.The randomized and controlled trials of microdiscectomy versus standard discectomy were collected.The included trials were screened out strictly based on the criterion of inclusion and exclusion. The quality of included trials was evaluated.Data were extracted by two reviewers independently.RevMan 5.0 was used for data analysis.Result：Nine studies involving 1109 patients were included.There were 654 patients with microdiscectomy and 455 standard discectomies.The results of Meta-analysis indicated that statistically significant difference were observed between two approaches with respect to the mean operation time （P 0.05）,blood loss（P0.01）,and postoperative VAS score of back pain（P0.01）.No difference with regard to the inpatient stay,complication,reoperation rate,postoperative VAS of leg pain and JOA score were noted.Conclu- sion：Both microdiscectomy and standard discectomy are effective treatment for LDH.Compared with standard open discectomy,microdiscectomy is better due to less blood loss and better back pain relief,but longeroperation time.There is no significant difference in overall effectiveness.

关 键 词：腰椎间盘突出症 微创椎间盘切除术 开放椎间盘切除术 META分析 

分 类 号：R687.3[医药卫生—骨科学]