单、双通道脊柱内镜治疗腰椎间盘突出症临床疗效的Meta分析  

The clinical efficacy of single and double channel spinal endoscopy in the treatment of lumbar disc herniation:a Meta-analysis

作　　者：林劲华 杨裕豪 林振 查丁胜[1] 李镇宏 郑力恒[2] 吴昊[1] LIN Jinhua;YANG Yuhao;LIN Zhen;ZHA Dingsheng;LI Zhenhong;ZHENG Liheng;WU Hao(The First Spinal Trauma Zone,The First Affiliated Hospital of Jinan University,Guangzhou 510630;Department of Orthopedic Surgery,Centro Hospitalar Conde de Sao Januario,Macao 999078,China)

机构地区：[1]暨南大学附属第一医院脊柱创伤一区,广州510630 [2]澳门仁伯爵综合医院骨科,中国澳门999078

出　　处：《颈腰痛杂志》2025年第1期106-115,共10页The Journal of Cervicodynia and Lumbodynia

基　　金：澳门科学技术发展基金(0003/2024/RIB1)。

摘　　要：目的通过Meta分析比较单、双通道(PELD、UBE)治疗腰椎间盘突出症(LDH)的疗效。方法计算机分别检索不同中英文数据库。检索时间为各数据库建库至2022年12月,收集关于UBE与PELD治疗LDH的临床对照试验。通过RevMan 5.4软件对提取出的数据进行Meta分析。评价指标有:腰腿部疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、改良MacNab标准评定、并发症、手术时长、术中出血量、住院时间和透视次数。结果最终纳入12篇文献,共纳入1089名患者,其中UBE组纳入536例患者,PEID组纳入553例患者。UBE组术后1~3个月腰痛VAS评分[WMD=0.21,95%CI(-0.14,0.29),P<0.01],术后1~3个月下肢痛VAS评分[WMD=0.12,95%CI(0.01,0.23),P=0.03],术后1周ODI[WMD=4.04,95%CI(0.73,7.34),P=0.02],术后1~3个月ODI[WMD=-0.71,95%CI(-1.36,-0.06),P=0.03],术后至少6个月的ODI[WMD=-0.69,95%CI(-1.25,-0.14),P=0.01],术后脑脊液漏[OR=2.96,95%CI(1.05,8.37),P=0.04],髓核残留[OR=0.25,95%CI(0.08,0.77),P=0.01],手术时长[WMD=22.06,95%CI(12.86,31.26),P<0.01],术中出血量[WMD=43.91,95%CI(24.70,63.12),P<0.01],术后住院时间[WMD=2.03,95%CI(0.82,3.24),P=0.001],其余纳入指标差异无统计学意义。结论UBE与PELD技术都是治疗LDH行之有效的微创术式,都值得在临床上推广,然而UBE技术需要克服学习曲线以减少并发症的发生。Objective To compare the efficacy of single and double channel(PELD,UBE)in the treatment of lumbar disc herniation(LDH)by Meta-analysis.Methods The computer scanned various Chinese and English databases.The search period was from the inception of each database to December 2022,and included controlled clinical trials of UBE and PELD for the treatment of LDH.Meta-analysis of the extracted data was performed by RevMan 5.4 software.The evaluation indexes included:visual analogue scale(VAS)of pain,Oswestry disability index(ODI),modified Macnab criteria,complications,the length of operation,intraoperative blood loss,hospitalization time and perspective times.Results A total of 12 articles were included,including 1089 patients,including 536 patients in the UBE group and 553 patients in the PEID group.In the UBE group,the VAS score of low back pain at 1-3 months after operation was[WMD=0.21,95%CI(-0.14,0.29),P<0.01]and the VAS score of lower limb pain at 1-3 months after operation was[WMD=0.12,95%CI(0.01,0.23),P=0.03].Conclusion Both UBE and PELD are effective minimally invasive procedures for the treatment of LDH,which are worthy of clinical promotion.However,UBE technology needs to overcome the learning curve to reduce the occurrence of complications.

关 键 词：腰椎间盘突出症 单侧双通道内镜 经皮内镜腰椎间盘切除术 META分析 临床疗效 微创化 

分 类 号：R681.5[医药卫生—骨科学]