青少年腰椎间盘突出症保守与手术治疗比较的Meta分析  

Surgical versus conservative treatment for adolescent lumbar disc herniation: a Meta-analysis

作　　者：张帮可 邹娜 王亮[1] 王海滨[1] 蒋家耀 卢旭华[1] ZHANG Bang-ke;ZOU Na;WANG Liang;WANG Hai-bin;JIANG Jia-yao;LU Xu-hua(Department of Orthopaedic Surgery,Changzheng Hospital,Shanghai,200003,China)

机构地区：[1]第二军医大学附属长征医院骨科,上海200003

出　　处：《中国骨与关节杂志》2018年第10期756-761,共6页Chinese Journal of Bone and Joint

摘　　要：目的系统评价保守与手术两种治疗方式对青少年腰椎间盘突出症的疗效。方法按照Cochrane系统评价的方法,计算机检索1945年至今的Pubmed数据库、Embase数据库、Web of Science数据库、Cochrane图书馆及中国生物医学数据库,手工检索相关杂志,语种不限。搜集国内外关于青少年腰椎间盘突出症治疗的前瞻性对照试验(随机或非随机)。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。提取相关数据利用RevMan 5.2进行Meta分析。结果共有6篇研究符合纳入标准,共274例青少年腰椎间盘突出症患者,保守治疗156例,手术治疗118例。Meta分析结果显示:保守治疗总体优良率不及手术治疗[OR=0.47,95%CI (0.24,0.91)],随访1年及5年以上结果均显示手术治疗优良率优于保守治疗(P=0.003,P=0.04),而随访时间<1年的结果显示保守与手术优良率差异无统计学意义(P>0.05),手术治疗再手术率与保守治疗中转手术率差异无统计学意义(P>0.05)。结论青少年腰椎间盘突出症手术治疗的中长期疗效优于保守治疗,手术治疗再手术率与保守治疗中转手术率差异无统计学意义。对于有适应证的青少年患者,经适当保守治疗无效时可尽早行手术治疗以取得较好疗效。Objective To compare the clinical efficacy of surgery and conservative therapy in adolescent patients with lumbar disc herniation. Methods We searched PubMed, EMBASE, Web of Science, Cochrane CENTRAL Database and Chinese Biomedical Literature Database with a highly sensitive search strategy. Prospective controlled trials（ randomized or nonrandomized） comparing the clinical efficacy of surgery and conservative therapy in adolescent patients with lumbar disc herniation were included. Data were extracted and Cochrane methodology was used for the results of this meta-analysis. Results Six prospective nonrandomized controlled trials with a total of 274（ conservative treatment： n = 156; surgical treatment： n = 118） adolescent patients fulfilled the inclusion criteria. All six trails were level III studies with control groups. The results of this meta-analysis showed a significantly lower overall good rate in conservative group than surgical group [ OR = 0.47, 95% CI（ 0.24, 0.91） ]. And there were no significant differences between reoperation rate in surgical group and transit operation rate in conservative group（ P〈0.05）. According to the subgroup meta-analyses, surgery showed a significantly higher good rate than conservative therapy when the follow-up was finished 1 year, as well as over 5 years（ P = 0.003, 0.04, respectively）. But there were no significant differences in the good rate between two groups when the follow-up was less than 1 year. ConclusionsSurgical treatment has a better mid-to long-term clinical efficacy than conservative treatment for adolescent patients with lumbar disc herniation. And there are no significant differences between reoperation rate of surgical treatment and transit operation rate of conservative treatment. Overall, for adolescent patients meeting the indications for surgery, surgical intervention may be considered earlier if a certain period of conservative treatment fails. Considering the low quality of the eligible trials, the evidence is weak. Thus high

关 键 词：青少年 椎间盘移位 腰椎 META分析 

分 类 号：R681.5[医药卫生—骨科学]