经皮内镜下经椎间孔与经椎板间隙入路椎间盘切除术治疗椎间盘突出症的Meta分析  

Percutaneous endoscopic transforaminal discectomy versus percutaneous endoscopic interlaminar discectomy for lumbar disc herniation: a Meta-analysis

作　　者：彭嘉杰 钟的桂 赖俊辉 黄永铨 苏海涛[2] Jia-jie Peng;De-gui Zhong;Jun-hui Lai;Yong-quan Huang;Hai-tao Su(The Second Clinical Medical College,Guangzhou University of Traditional Chinese Medicine,Guangzhou,Guangdong 510405,China;Department of Orthopaedics,Guangdong ProvincialHospital of Traditional Chinese Medicine,Guangzhou,Guangdong 510006,China)

机构地区：[1]广州中医药大学第二临床医学院,广东广州510405 [2]广东省中医院骨科,广东广州510006

出　　处：《中国内镜杂志》2018年第8期20-29,共10页China Journal of Endoscopy

基　　金：广东省中医药局科研项目(No:20182043)

摘　　要：目的通过Meta分析比较经皮内镜下经椎间孔椎间盘切除术(PETD)与经皮内镜下经椎板间隙入路椎间盘切除术(PEID)治疗腰椎间盘突出症的临床疗效。方法通过计算机检索建库至2018年1月Pub Med、Embase、Cochrane Library、中国知网、万方和维普6个数据库,收集PETD与PEID治疗椎间盘突出症的相关文章,按照标准纳入文章,并由两位作者进行独立筛选。运用纽卡斯尔-渥太华量表(NOS)对文章进行质量评分。对文章中的数据进行提取后,应用Review Manager 5.3软件对其数据进行分析。结果此次Meta分析共纳入18篇相关研究,共1 149例患者。其中,PETD组597例,PEID组552例。PEID手术时间短于PETD(P<0.05),PEID术中透视次数少于PETD(P<0.05),PETD手术并发症少于PEID(P<0.05),而术后1 d、3个月、6个月、1年疼痛视觉模拟评分(VAS)的比较、术后1 d、3个月、1年的Oswestry功能障碍指数评分(ODI)的比较、术后疗效优良率的比较、术后复发或残留的比较,差异均无统计学意义(均P>0.05)。结论 PETD和PEID治疗腰椎间盘突出症效果明确且疗效相当,两种入路各有优缺点,适应证存在重叠,亦有不同,故需结合临床实际情况选择合适的入路。Objective To analyze the clinical effect of percutaneous endoscopic transforaminal discectomy（PETD） and percutaneous endoscopic interlaminar discectomy（PEID） in the treatment of lumbar disc herniation. Methods Pub Med, Embase, Cochrane Library, CNKI, WANFANG and VIP were searched by computer to collect the articles about PETD and PEID in the treatment of disc herniation up to January 2018. The articles were included according to the standard and two authors reviewed all articles individually. All articles were evaluated by the modified Newcastle-Ottawa scale, and after data extraction, Rev Man 5.3 was used to perform a Metaanalysis. Results Finally, 18 articles with 1 149 patients were included in this Meta-analysis, with 597 patients in PETD group and 552 patients in PEID group. The operation time was shorter in PEID group（P〈0.05）, the X-rayirradiation time was fewer in PEID group（P〈0.05）, the complications were fewer in PETD group（P〈0.05）. However, the comparisons of VAS after 1 d, VAS after 3 m, VAS after 6 m, VAS after 1 y, the comparisons of ODI after 1 d, ODI after 3 m, ODI after 1 y, excellent and good outcomes rate and recurrence or residual showed no significant differences between the two groups（P〉0.05）. Conclusion Both PETD and PEID are effective and similar in the treatment of lumbar disc herniation. These two approaches have its＇ advantages and disadvantages respectively. There are different and overlap indications. Therefore, it is necessary to select a proper approach according to the clinical situation.

关 键 词：META分析 腰椎间盘突出症 经皮内镜 经椎间孔入路 经椎板间隙入路 

分 类 号：R681.53[医药卫生—骨科学]