单侧双通道脊柱内镜与显微内镜下减压术治疗腰椎管狭窄症疗效的Meta分析  

Clinical efficacy and safety of unilateral biportal endoscopy versus microendoscopic discectomy in treatment of lumbar spinal stenosis:a Meta-analysis

作　　者：贺少杰 查丁胜[1] 黄嘉文 赵振宇 唐晟 赖晓锋 吴昊[1] He Shaojie;Zha Dingsheng;Huang Jiawen;Zhao Zhenyu;Tang Sheng;Lai Xiaofeng;Wu Hao(Department of Orthopaedics,The First Affiliated Hospital,Jinan University,Guangzhou 510630,China)

机构地区：[1]暨南大学附属第一医院骨科,广州510630

出　　处：《中华创伤骨科杂志》2022年第7期634-639,共6页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金青年项目(81401766);广州市科技计划项目(201904010060);暨南大学科研培育与创新基金青年基金(21612303);暨南大学虚拟仿真训练项目(XF202211);暨南大学"互联网+多元化教学"体验式骨科实践教学改革研究(JG2022099)。

摘　　要：目的通过Meta分析比较单侧双通道脊柱内镜(UBE)、显微内镜下减压术(MED)治疗腰椎管狭窄症(LSS)的疗效。方法计算机检索PubMed、Web of Science、中国知网(CNKI)、万方数据库从建库到2021年1月UBE与MED治疗LSS的所有研究。获取文献的作者、发表年份、研究设计、受试者特征、样本大小、手术方案、年龄、性别比、手术时间、住院时间、并发症、视觉模拟评分(VAS)、Oswestry残疾指数(ODI)。将手术时间,住院时间,并发症发生率,术前、术后早期、末次随访时的腰部、下肢VAS评分、ODI通过Revman 5.3软件进行Meta分析。结果最终纳入7篇文献,其中6篇为英文文献,1篇为中文文献;2篇为随机对照研究,5篇为病例对照研究。UBE组纳入251例患者,显微镜组纳入224例患者。相较于MED组,UBE组住院时间更短(MD=-2.28,95%CI:-3.42~-1.14,P<0.001),术后早期腰痛VAS评分更低(MD=-0.80,95%CI:-1.44~-0.16,P=0.01),差异均有统计学意义。两组手术时间,并发症发生率,术前、末次随访时的腰部VAS评分,术前、术后早期和末次随访时的下肢VAS评分、ODI、硬脑膜扩张面积比较差异均无统计学意义(P>0.05)。结论相较于MED,UBE治疗LSS术后早期腰痛缓解及住院时间更佳,但在远期疗效和安全性方面无显著差异。Objective To compare the efficacy and safety of unilateral biportal endoscopy(UBE)and microendoscopic discectomy(MED)in the treatment of lumbar spinal stenosis by Meta-analysis.Methods PubMed,Web of Science,CNKI and Wanfang Data were searched from their establishment to January 2021 for all the studies on UBE and MED in the treatment of lumbar spinal stenosis.The data extracted were authors,year of publication,study design,subject characteristics,sample size,surgical protocol,age,sex ratio,duration of surgery,length of hospital stay,complications,visual analogue scale(VAS),and Oswestry Disability Index(ODI).The Meta-analysis was conducted with software Revman 5.3 to analyze the operation time,hospital stay,complication rate,waist and lower extremity VAS scores and ODI scores at preoperation,early postoperation and the last follow-up.The quality of the case-control studies included was evaluated using the Newcastle Ottawa Scale(NOS)while the methodological quality and risk of bias of the randomized controlled studies(RCT)included were evaluated using the Cochrane Bias Risk Assessment Tool.Results Finally,7 studies were included,6 in English and one in Chinese.There were 2 RCTs and 5 case-control studies.There were 251 patients in the UBE group and 224 patients in the MED group.Compared with the MED group,the UBE group had a significantly shorter hospital stay(MD=-2.28,95%CI:-3.42 to-1.14,P<0.001),and a significantly lower VAS score for early postoperative low back pain(MD=-0.80,95%CI:-1.44 to-0.16,P=0.01).There were no significant differences between the 2 groups in operation time,complication rate,waist VAS scores at preoperation or the last follow-up,lower extremity VAS or ODI scores at preoperation,early postoperation or the last follow-up,or dural dilatation area(P>0.05).Conclusions In the treatment of lumbar spinal stenosis,compared with MED,UBE is superior in early relief of low back pain and hospital stay after operation,but shows no significant difference in long-term efficacy or safety.

关 键 词：椎管狭窄 内镜手术 META分析 显微内镜 单侧双通道脊柱内镜 

分 类 号：R687.3[医药卫生—骨科学]