不同手术方式治疗腰椎间盘突出症的网状Meta分析  

A network meta-analysis of different surgical methods in the treatment of lumbar disc herniation

作　　者：向熙 司群超 成伟益 曹平[1] 郑金鹏 胡冰[1] Xiang Xi;Si Qunchao;Cheng Weiyi;Cao Ping;Zheng Jinpeng;Hu Bing(Department of Orthopedics,Tianyou Hospital Affiliated to Wuhan University of Science and Technology,Wuhan 430000,Hubei Province,China;Maternal and Child Health Care Hospital of Hubei Province,Wuhan 430000,Hubei Province,China)

机构地区：[1]武汉科技大学附属天佑医院骨科,湖北省武汉市430000 [2]湖北省妇幼保健院,湖北省武汉市430000

出　　处：《中国组织工程研究》2020年第27期4398-4405,共8页Chinese Journal of Tissue Engineering Research

摘　　要：背景:目前用于治疗腰椎间盘突出症的手术方式较多,治疗效果各有优势,虽然已有许多Meta分析比较两两手术方式的疗效,但缺乏几种手术方式疗效的比较。目的:应用网状Meta分析方法比较不同手术方式治疗腰椎间盘突出症的差异。方法:检索Pub Med、Embase、Cochrane Library、Ovid和中国知网数据库,收集有关不同手术方式治疗腰椎间盘突出症的随机对照试验或回顾性研究。按预先制定的纳入排除标准进行筛选,并对纳入的随机对照试验进行质量评价,采用STATA 15.0软件进行数据分析。结果与结论:共纳入42个研究,5156例患者,涉及9种手术治疗方式,包括腰椎间盘置换术、腰椎间盘融合术、标准椎间盘切除术、椎间盘镜下髓核摘除术、显微镜下髓核摘除术、经皮内窥镜腰椎间盘切除术、化学溶核术、自动经皮腰椎间盘切除术和经皮激光椎间盘减压术。网状Meta分析显示(从优至劣):(1)缓解腿痛疗效方面排序为经皮激光椎间盘减压术>椎间盘镜下髓核摘除术>经皮内窥镜腰椎间盘切除术>标准椎间盘切除术>显微镜下髓核摘除术>腰椎间盘融合术>腰椎间盘置换术,差异无显著性意义;(2)缓解腰痛疗效方面排序为腰椎间盘置换术>腰椎间盘融合术>椎间盘镜下髓核摘除术>经皮内窥镜腰椎间盘切除术>显微镜下髓核摘除术>经皮激光椎间盘减压术>标准椎间盘切除术,部分差异有显著性意义;(3)改善Oswestry功能障碍指数方面排序为椎间盘镜下髓核摘除术>经皮内窥镜腰椎间盘切除术>标准椎间盘切除术>显微镜下髓核摘除术>腰椎间盘置换术>腰椎间盘融合术,差异无显著性意义;(4)手术成功率方面排序为腰椎间盘置换术>腰椎间盘融合术>椎间盘镜下髓核摘除术>经皮内窥镜腰椎间盘切除术>标准椎间盘切除术>经皮激光椎间盘减压术>显微镜下髓核摘除术>化学溶核术>自动经皮腰椎间盘切除术,�BACKGROUND: At present, there are many surgical methods for the treatment of lumbar disc herniation, and the therapeutic effects have their own advantages. Although there are many meta-analyses to compare the therapeutic effects of the two surgical methods, there is no comparison of the therapeutic effects of several surgical methods. OBJECTIVE: To compare the differences of different surgical methods in the treatment of lumbar disc herniation by network meta-analysis. METHODS: PubMed, Embase, Cochrane Library, Ovid and CNKI were searched, and randomized controlled trials or retrospective studies on different surgical methods for the treatment of lumbar disc herniation were collected. According to the inclusion and exclusion criteria established in advance, the quality of included randomized controlled trials was evaluated, and the data were analyzed by STATA 15.0 software. RESULTS AND CONCLUSION: A total of 42 studies, 5 156 patients and 9 surgical treatments were included. Surgical treatments contain total disc replacement, lumbar disc fusion, standard open discectomy, microendoscopic discectomy, microdiscectomy, percutaneous endoscopic lumbar discectomy, chemonucleolysis, automatic percutaneous lumbar discectomy and percutaneous laser disc decompression. The results of network meta-analysis showed that(from best to worst):(1) There was no significant difference in leg pain relief, and the rank probability was percutaneous laser disc decompression > microendoscopic discectomy > percutaneous endoscopic lumbar discectomy > standard open discectomy > microdiscectomy > lumbar disc fusion > total disc replacement.(2) There was no significant difference in low back pain relief, and the rank probability was total disc replacement > lumbar disc fusion > microendoscopic discectomy > percutaneous endoscopic lumbar discectomy > microdiscectomy > percutaneous laser disc decompression > standard open discectomy.(3) There was no significant difference in Oswestry disability index scores, and the rank probability was microend

关 键 词：腰椎间盘突出症 网状Meta分析 手术治疗 经皮内窥镜腰椎间盘切除术 椎间盘镜下髓核摘除术 显微镜下髓核摘除术 腰椎间盘置换术 腰椎间盘融合术 

分 类 号：R459.9[医药卫生—治疗学] R319[医药卫生—临床医学]