可视化环锯技术辅助经皮椎间孔入路内镜下椎间盘切除术治疗腰椎间盘突出症有效性与安全性的Meta分析  

Clinical outcomes and safety of visual trephine-assisted percutaneous endoscopic transforaminal discectomy for treatment of lumbar disc herniation:a meta-analysis

作　　者：杨磊 陈锋[2] 吴晓飞 刘宁 YANG Lei;CHEN Feng;WU Xiaofei;LIU Ning(Postgraduate College of Guangxi University of Chinese Medicine,Nanning 530001,Guangxi,China;Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine,Nanning 530011,Guangxi,China;Guangxi Orthopaedic Hospital,Nanning 530012,Guangxi,China)

机构地区：[1]广西中医药大学研究生院,广西南宁530001 [2]广西中医药大学附属瑞康医院,广西南宁530011 [3]广西骨伤医院,广西南宁530012

出　　处：《中医正骨》2024年第8期35-40,共6页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：国家自然科学基金项目(82360936);广西中西医结合骨与关节退行性疾病多学科交叉创新团队项目(GZKJ2310);第七批全国老中医药专家学术经验继承工作项目(国中医药人教函[2022]76号);广西名中医传承工作室建设项目(桂中医药科教发[2021]6号)。

摘　　要：目的:系统评价可视化环锯辅助经皮椎间孔入路内镜下椎间盘切除术(percutaneous endoscopic transforaminal discectomy,PETD)治疗腰椎间盘突出症(lumbar disc herniation,LDH)的有效性和安全性。方法:检索中国知网、万方数据库、维普网、中国生物医学文献服务系统、PubMed、Embase、Cochrane Library中比较可视化环锯和传统环锯辅助PETD治疗LDH有效性和安全性的随机对照试验和回顾性临床研究文献,检索时限为数据库建库至2023年11月30日。由2名研究人员独立筛选文献、提取数据并评价纳入研究的文献质量后,采用RevMan5.3软件进行Meta分析。结果:共纳入10项研究,其中随机对照试验2项、回顾性临床研究8项;共涉及756例患者,其中可视化环锯组377例、传统环锯组379例。Meta分析结果显示,与传统环锯组相比,可视化环锯组手术时间更短[MD=-10.40,95%CI(-12.08,-8.71),P=0.000]、术中X线透视次数和术中出血量更少[MD=-6.67,95%CI(-6.94,-6.40),P=0.000;MD=-2.22,95%CI(-3.56,-0.89),P=0.001]、腿部疼痛缓解更明显[MD=-0.28,95%CI(-0.43,0.14),P=0.000]。2组Oswestry功能障碍指数、腰部疼痛视觉模拟量表评分、日本骨科协会腰痛疾患疗效评分、术后疗效优良率、术后并发症发生率的组间差异均无统计学意义。结论:现有的证据表明,相较于传统环锯辅助PETD,采用可视化环锯辅助PETD治疗LDH,可缩短手术时间、减少术中X线透视次数和出血量、减轻腿部疼痛症状。Objective:To systematically review the clinical outcomes and safety of visual trephine-assisted percutaneous endoscopic transforaminal discectomy(PETD)in treatment of lumbar disc herniation(LDH).Methods:All the randomized controlled trial(RCT)articles and retrospective clinical trial articles about the clinical outcomes and safety of visual trephine versus traditional trephine-assisted PETD for treatment of LDH included from database’s inception to November 30,2023 were retrieved from the China National Knowledge Infrastructure,Wanfang Database,Vip Database,Chinese Biomedical Literature Service System,PubMed,Embase and Cochrane Library.The pertinent articles were screened,the information was extracted and the methodological quality of the included researches in the articles was assessed independently by two researchers,and then a Meta-analysis was conducted by using RevMan5.3 software.Results:Ten articles were included in the final analysis,including 2 RCT articles and 8 retrospective clinical trial articles,with 377 patients in visual trephine group and 379 ones in traditional trephine group.The results of Meta-analysis revealed that the operative time was shorter,intraoperative X-ray exposure was fewer,intraoperative blood loss was less,and leg pain relieved more significantly in visual trephine group compared to traditional trephine group(MD=-10.40,95%CI(-12.08,-8.71),P=0.000;MD=-6.67,95%CI(-6.94,-6.40),P=0.000;MD=-2.22,95%CI(-3.56,-0.89),P=0.001;MD=-0.28,95%CI(-0.43,0.14),P=0.000),while,there was no statistical difference in Oswestry disability index(ODI),low back pain visual analogue scale(VAS)score,Japanese Orthopedic Association(JOA)low back pain efficacy score,postoperative excellent and good rate of efficacy,as well as postoperative complication incidence rate between the 2 groups.Conclusion:Available evidences suggest that,compared to the traditional trephine-assisted PETD,the visual trephine-assisted PETD can shorten the operative time,reduce intraoperative X-ray exposure and blood loss,as well as al

关 键 词：椎间盘移位 腰椎 椎间盘切除术 经皮 内窥镜检查 可视化环锯 专题Meta分析 

分 类 号：R687.3[医药卫生—骨科学] G353.1[医药卫生—外科学]