经皮内窥镜下腰椎椎间盘切除术与显微内窥镜下椎间盘切除术治疗腰椎椎间盘突出症的荟萃分析  

Percutaneous endoscopic lumbar discectomy versus micro endoscopic discectomy for lumbar disc herniation:a meta-analysis

作　　者：曹志武 陈刚 曾凯斌 Cao Zhiwu;Chen Gang;Zeng Kaibin(Department of Spinal Surgery,Xiangtan Central Hospital,Xiangtan 411100,Hunan,China)

机构地区：[1]湘潭市中心医院脊柱外科,湘潭411100

出　　处：《脊柱外科杂志》2021年第1期46-54,共9页Journal of Spinal Surgery

摘　　要：目的系统分析并比较经皮内窥镜下腰椎椎间盘切除术(PELD)与显微内窥镜下椎间盘切除术(MED)治疗腰椎椎间盘突出症(LDH)的疗效。方法利用中国知网、万方数据、维普网、中国生物医学数据库、PubMed、Embase、Cochrane Library、Ovid等数据库,检索国内外公开发表的治疗单节段LDH的中英文文献,检索时间为建库至2019年11月20日。收集关于PELD与MED治疗LDH的前瞻性随机对照研究。根据纳入与排除标准进行文献筛选、质量评价和资料提取。采用RevMan 5.3软件对数据进行荟萃分析。结果最终纳入10项研究,受试者总计956例,男523例,女433例;其中,PELD组455例,MED组501例。荟萃分析结果表明,2组手术时间、术后腰腿痛视觉模拟量表(VAS)评分、术后Oswestry功能障碍指数(ODI)、术后并发症发生率及二次手术率差异无统计学意义(P>0.05);与MED组相比,PELD组手术切口小、术后卧床及住院时间短,但术中透视次数多,差异均具有统计学意义(P<0.05)。结论PELD与MED均是治疗LDH的有效方式,安全性相当,PELD具有手术切口小、术后卧床及住院时间短等优势,但术中射线暴露增加。Objective To systematically analyze and compare the effectiveness between percutaneous endoscopic lumbar discectomy(PELD)and micro endoscopic discectomy(MED)in the treatment of lumbar disc herniation(LDH).Methods CNKI,Wanfang Database,VIP,China Biological Medicine Database,PubMed,Embase,Cochrane Library and Ovid were searched for the articles in the treatment of single-segmental LDH published from the building of data base to November 20,2019.Prospective randomized controlled trials of PELD and MED in the treatment of LDH were collected.The eligible trials were extracted according to the inclusion and exclusion criteria.The RevMen 5.3 software was used for meta analysis.Results A total of 10 trials involving 956 patients were included,523 male and 433 female,455 PELD cases and 501 MED cases were enrolled.The results of meta-analysis showed that there were no significant differences in the mean operation time,visual analogue scale(VAS)score of postoperative low back pain and leg pain,the Oswestry disability index(ODI),the postoperative complication rate and re-operation rate.When compared with MED,PELD entailed shorter length of incision,in-bed time after operation and hospital stay,and higher radiation exposure,all with a significant difference(P<0.05).Conclusion PELD and MED are both effective and safe treatments for LDH.Compared to MED,PELD is more minimally invasive with shorter length of incision,in-bed time and hospital stay,but increases risk of intraoperative radiation exposure.

关 键 词：腰椎 椎间盘移位 内窥镜检查 椎间盘切除术 经皮 外科手术 微创性 荟萃分析 

分 类 号：R681.533.1[医药卫生—骨科学]