腰椎间盘突出症7种手术修复方式差异的网络Meta分析  

Comparison of seven surgical interventions for lumbar disc herniation: a network meta-analysis

作　　者：冯帆[1] 蔡毅[1] 李颖波 董军立 吴群[1] 樊永智 严虹 Feng Fan;Cai Yi;Li Yingbo;Dong Junli;Wu Qun;Fan Yongzhi;Yan Hong(Department of Pain,the Central Hospital of Wuhan,Huazhong University of Science and Technology,Wuhan 430014,Hubei Province,China;Department of Anesthesiology,the Central Hospital of Wuhan,Huazhong University of Science and Technology,Wuhan 430014,Hubei Province,China)

机构地区：[1]华中科技大学附属武汉市中心医院疼痛科,湖北省武汉市430014 [2]华中科技大学附属武汉市中心医院麻醉科,湖北省武汉市430014

出　　处：《中国组织工程研究》2020年第3期453-459,共7页Chinese Journal of Tissue Engineering Research

摘　　要：背景:随着椎间盘介入技术的快速发展,治疗腰椎间盘突出症的手术方式在取得长足进步的同时也让外科医生和患者有了更多的选择余地。因此新兴手术方式和传统广为接受治疗方式的治疗效果以及安全性的比较就显得尤为重要。传统的荟萃分析无法对多种手术方式的优劣进行层级划分。目的:通过网状Meta分析的方式,对临床上常用的7种治疗腰椎间盘突出症手术方式的疗效及安全进行评估。方法:通过贝叶斯网状Meta分析模型,对经皮穿刺椎间孔镜技术、标准椎间盘切除、标准小开窗椎间盘切除、椎间盘化学消融、椎间盘镜技术、经皮激光椎间盘汽化减压、自动式经皮穿刺腰椎间盘切吸技术治疗腰椎间盘突出症的随机对照试验研究进行荟萃分析。所有符合条件的随机对照试验均从the Cochrane Central Register of Controlled Trials(CENTRAL)、PubMed、Embase以及Google scholar检索得来。检索提取结果数据包括手术成功率、并发症发生率和再手术率,数据由2名评价员独立提取。结果与结论:①共纳入29个研究31篇文献,包括3146例患者;②7种手术方式成功率的概率排序(从优至劣):经皮穿刺椎间孔镜技术>标准椎间盘切除>标准小开窗椎间盘切除>椎间盘化学消融>椎间盘镜技术>经皮激光椎间盘汽化减压>自动式经皮穿刺腰椎间盘切吸;③手术并发症发生率的概率排序(从优至劣):经皮穿刺椎间孔镜技术>标准的小开窗椎间盘切除>标准椎间盘切除>椎间盘镜技术>经皮激光椎间盘汽化减压>椎间盘化学消融>自动式经皮穿刺腰椎间盘切吸;④再次手术率的概率排序(从优至劣):标准小开窗椎间盘切除>标准椎间盘切除>椎间盘镜技术>经皮激光椎间盘汽化减压>经皮穿刺椎间孔镜技术>椎间盘化学消融>自动式经皮穿刺腰椎间盘切吸;⑤研究证据显示,经皮穿刺椎间孔镜技术具有最高的手术成功率,其BACKGROUND: With the rapid development of intervertebral disc interventional technology, surgical treatment of lumbar disc herniation has made great progress, but at the same time, surgeons and patients have more choices. Therefore, it is particularly important to compare the efficacy and safety of new surgical methods and traditional widely accepted treatment methods. Traditional meta-analysis cannot classify the advantages and disadvantages of various surgical methods. OBJECTIVE: To evaluate the efficacy and safety of seven surgical interventions for the treatment of lumbar disc herniation using network meta-analysis. METHODS: We performed a Bayesian-framework network meta-analysis of randomized controlled trials to compare seven surgical interventions for people with lumbar disc herniation, including percutaneous endoscopic lumbar discectomy, standard open discectomy, standard open microsurgical discectomy, chemonucleolysis, microendoscopic discectomy, percutaneous laser disc decompression, and automated percutaneous lumbar discectomy. The eligible randomized controlled trials were identified by searching the Cochrane Central Register of Controlled Trials(CENTRAL), PubMed, Embase and Google scholar. Data from three outcomes(success rate, complication rate, and reoperation rate) were independently extracted by two assessors. RESULTS AND CONCLUSION:(1) A total of 29 randomized controlled trials(31 literatures) including 3 146 participants were finally included into this article.(2) Our Meta-analysis provides hierarchies of these seven interventions. For the success rate, the rank probability is as follows(from best to worst): percutaneous endoscopic lumbar discectomy > standard open discectomy > standard open microsurgical discectomy > chemonucleolysis > microendoscopic discectomy > percutaneous laser disc decompression > automated percutaneous lumbar discectomy.(3) For the complication rate, the rank probability is as follows(from best to worst): percutaneous endoscopic lumbar discectomy > standard open microsu

关 键 词：腰椎间盘突出症 腰椎间盘切除 微创手术 手术成功率 并发症 再手术率 网状Meta分析 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]