微创手术与开放椎板切除术治疗LSS疗效与安全性的Meta分析  

Efficacy and safety of minimally invasive surgery versus open laminectomy in the treatment of lumbar spinal stenosis:a Meta analysis

作　　者：李江华[1] 陈磊[1] 戴毅 曹成彰 蒋雯[1] 史晨辉[1] LI Jianghua;CHEN Lei;DAI Yi;CAO Chengzhang;JIANG Wen;SHI Chenhui(Department of Orthopedics Center,the First Affiliated Hospital of the Medical College,Shihezi University,Shihezi,Xinjiang 832000,China)

机构地区：[1]石河子大学医学院第一附属医院骨科中心,新疆石河子832000

出　　处：《重庆医学》2018年第31期4022-4026,4032,共6页Chongqing medicine

基　　金：国家自然科学基金资助项目(81260453;81360451);新疆兵团医药卫生专项资助(2013BA020);兵团国际交流与合作专项资助(2012BC002;2011BC004);兵团科技创新团队专项基金资助项目(2014CC002);兵团青年科技创新领军人才专项(2016BC001)

摘　　要：目的系统评价微创手术与开放椎弓根板切除术治疗腰椎管狭窄症(LSS)的疗效和安全性。方法计算机检索The Cochrane Library(2017年第8期),PubMed、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、维普数据库(VIP)和万方数据库,检索时间均为建库至2017年8月。查找主题相关的随机对照试验(RCT)和队列研究,采用RevMan 5.3软件进行Meta分析。结果最终纳入5个RCT,11个回顾性队列研究,共1 561例患者。Meta分析结果显示,在患者满意度和术后视觉模拟评分(VAS)方面,微创手术组均明显优于开放手术组(OR=1.76,95%CI:1.15~2.68,P<0.05;MD=-2.11,95%CI:-2.62^-1.60,P<0.05);同时微创手术组具有更短的住院时间(MD=-3.09,95%CI:-4.19^-1.19,P<0.05)和更少的术中失血量(MD=-85.55,95%CI:-150.87^-20.23,P=0.01);但开放手术组具有更低的再次手术率(OR=0.32,95%CI:0.14~0.75,P<0.05)和更短的手术时间(MD=8.66,95%CI:3.33~13.99,P<0.05)。二者在硬脊膜受损率和手术切口感染率方面差异无统计学意义(OR=0.70,95%CI:0.41~1.22,P=0.21;OR=0.78,95%CI:0.31~1.96,P=0.60)。结论与传统开放手术相比,微创手术在治疗LSS疗效和安全性方面具有明显优势,但开放手术具有更低的再次手术率和更短的手术时间。Objective To systematically review the efficacy and safety of minimally invasive versus open laminectomy for patients with lumbar spinal stenosis.Methods The Cochrane Library(Issue 8,2017),PubMed,CBM,CNKI,VIP and WanFang Data were electronically searched since the establishment of the databases to August 2017,found randomized controlled trials(RCT)and cohort studies related to the topics,Meta analysis was conducted by using RevMan 5.3 software.Results Five RCTs and 11 cohort studies involving 1 561 patients were finally included.The Meta-analysis showed that the minimally invasive group had significant advantages for patients with satisfaction and postoperative VAS scores(OR=1.76,95%CI:1.15-2.68,P<0.05;MD=-2.11,95%CI:-2.62--1.60,P<0.05).Meanwhile,the minimally invasive group had shorter hospital stay(MD=-3.09,95%CI:-4.19--1.19,P<0.05)and less blood loss(MD=-85.55,95%CI:-150.87--20.23,P=0.01);but the open laminectomy group had lower reoperations rate(OR=0.32,95%CI:0.14-0.75,P<0.05)and shorter operation duration(MD=8.66,95%CI:3.33-13.99,P<0.05).There were no differences between the two groups in dural injury rate(OR=0.70,95%CI:0.41-1.22,P=0.21)and operative incision infection rate(OR=0.78,95%CI:0.31-1.96,P=0.60).Conclusion Compared with the open laminectomy group,the minimally invasive group has better efficacy and safety,but the open laminectomy group has lower reoperations rate and shorter operation duration.

关 键 词：腰椎管狭窄症 微创 椎板切除术 椎间孔镜 META分析 

分 类 号：R687.3[医药卫生—骨科学]