显微镜下与传统髓核摘除治疗腰椎间盘突出症疗效的Meta分析  

Comparison of Microscope-Assisted Discectomy and Opening Fenestration Discectomy for Lumbar Disc Herniation with Meta-Analysis

作　　者：苏其昌[1] 张汉庆[2] 王晓慧 SU Qichang;ZHANG Hanqing;WANG Xiaohui(Department of Postgraduate,Jianghan University,Wuhan 430056,Hubei,China;Wuhan Hospital of Traditional Chinese Medicine,Wuhan 430010,Hubei,China;The No.5 Hospital of Wuhan,Wuhan 430050,Hubei,China)

机构地区：[1]江汉大学研究生部,湖北武汉430056 [2]武汉市中医医院,湖北武汉430010 [3]武汉市第五医院,湖北武汉430050

出　　处：《江汉大学学报（自然科学版）》2017年第4期348-354,共7页Journal of Jianghan University：Natural Science Edition

摘　　要：目的应用Meta分析方法评价显微镜下与传统髓核摘除治疗腰椎间盘突出症的疗效差异。方法计算机检索Pub Med、Cochrane Library、中国生物医学文献数据库(Sino Med)、中国知网(CNKI)、万方数据库(Wanfang Standards Database),检索日期至2017年1月,搜集关于显微镜下与传统髓核摘除治疗腰椎间盘突出症的随机对照试验。严格评价纳入研究的方法学质量并提取资料,统计软件采用Rev Man 5.3。结果共纳入7篇随机对照试验文献,其中外文2篇,中文5篇,共918例手术,其中显微组461例,传统组457例。根据改良后的Jadad评分标准,有6篇为高质量文献,1篇为低质量文献,偏倚风险评估为中等。Meta分析显示,显微组切口小于传统组[MD=-2.16,95%CI(-2.88,-1.44),P<0.000 01<0.05];显微组术中出血量少于传统组[MD=-43.65,95%CI(-52.19,-35.11),P<0.000 01<0.05];显微组手术时间与传统组比较无统计学意义(P=0.92);显微组住院时间少于传统组[MD=-2.52,95%CI(-4.35,-0.69),P=0.007<0.05];显微组术后优良率与传统组相比差异无统计学意义(P=0.76>0.05);显微组术后VAS评分与传统组相比差异无统计学意义(P=0.13>0.05)。结论显微镜下与传统髓核摘除相比,具有切口小、术中出血少、住院时间缩短等优点,值得临床推广,但手术时间、术后疗效优良率与疼痛改善情况无明显差异,临床医师可根据自身经验与实际情况选择手术方式。Objective To evaluate the therapeutic effect of microscopic and traditional nucleus pulposus discectomy for lumbar disc herniation with Meta-analysis.Methods PubMed,Cochrane Library,SinoMed,CNKI and Wanfang Standards Database were searched.The retrieval date was till Jan.2017.The results of microscopic discectomy were compared with those of traditional nucleus pulposus discectomy,with randomized controlled trial of lumbar disc herniation.The study strictly evaluated the quality of the methodology incorporated into the study and extracted the data,with software RevMan5.3.Results A total of7randomized controlled trials were included,2in foreign language,5in Chinese,918in surgery,461in microscopic group and457in the traditional group.According to the improved Jadad score,6were high quality literatures,1was low quality literature,and the bias risk assessment was moderate.The Meta analysis showed the incisons of microscopic group were smaller than those of traditional group(MD=-2.16,95%CI(-2.88,-1.44),P<0.00001<0.05).Microscopic group had less blood loss than that of traditional group(MD=-43.65,95%CI(-52.19,-35.11),P<0.00001<0.05).There was no significant difference of operation time between the two groups(P=0.92).The time of hospitalization in the microscopic group was significantly lower than that in the traditional group(MD=-2.52,95%CI(-4.35,-0.69),P=0.007<0.05).There was no significant difference of excellent rate between the two groups(P=0.76>0.05).There was no significant difference of VAS score between the two groups(P=0.13>0.05).Conclusion Compared with the traditional nucleus pulposus discectomy,the microscopic discectomy has the advantages of smaller incision,less intraoperative bleeding and shorter hospitalization time.It is worthy of clinical practice.However,there is no significant difference of the operation time,the excellent rate of postoperative improvement and the pain improvement.The surgeon can choose the surgical approach according to their own experience and the actual situation.

关 键 词：腰椎间盘突出症 髓核摘除 显微镜 META分析 

分 类 号：R681.53[医药卫生—骨科学]