摘要
目的比较经皮内镜腰椎间盘切除术(PELD)和后路开放显微腰椎间盘切除术(OLMD)治疗单节段腰椎间盘突出症(LDH)的疗效差异。方法通过PubMed、Cochrane Library、Embase和MEDLINE等数据库,对1973年1月至2018年12月采用PELD和OLMD治疗单节段LDH的英文文献进行检索,筛选符合纳入标准的随机试验和观察性研究,由2名研究员分别提取数据,评估偏倚风险,采用Review Manager 5.3软件进行Meta分析。结果共纳入11篇文献(3项随机对照试验、8项非随机对照试验),文献质量均被评估为适度到高质量,包括1826名患者,其中获得末次随访的患者有1763名(随访率96.55%)。PELD治疗组744例,OLMD治疗组1082例,两种术式均安全有效。在手术时间,并发症发生率,复发率,术前及术后12、24个月腰腿痛视觉模拟量表(VAS)评分及Oswestry功能障碍指数(ODI),MacNab标准优良率方面,两组比较差异无统计学意义(P>0.05);而在住院时间和复工时间上PELD更具优势,但OLMD组具有更低的再手术率(P<0.05)。结论与OLMD相比,PELD治疗单节段LDH创伤更加轻微,在促进患者术后快速康复方面表现更为优异;OLMD则具有再手术率更低的特点。系统评价显示PELD切口更小,但有一定的学习曲线;OLMD辐射量更少。临床上PELD能否替代OLMD作为“金标准术式”,仍需更多高质量临床证据的支持。
Objective To compare the differences of clinical efficacy between percutaneous endoscopic lumbar discectomy(PELD)and open lumbar microdiscectomy(OLMD)in the treatment of single-level lumbar disc herniation(LDH).Methods With medical databases such as PubMed,Cochrane Library,Embase and MEDLINE,a literature retrieval was conducted focus on English papers involved treatment of PELD and OLMD for single level LDH from January 1973 to Decemeber 2018,and then the randomized trials and observational studies which met the inclusion criteria were screened out.Two reviewers extracted the data and evaluated the risks of the bias respectively.Meta analyses were performed using Review Manager 5.3 software.Results A total of 11 studies,3 randomized controlled and 8 non-randomized controlled studies were included,all of them were evaluated as moderate to high quality.Among 1826 patients who involved in the study,1763 obtained last follow-up(the follow-up rate was 96.55%).There were 744 patients in PELD group and 1082 in OLMD group,both of procedures were safe and effective.There were no significant differences in operation time,complication incidence,recurrence rate,visual analogue scale(VAS)score of back and leg pain as well as Oswestry disability index(ODI)preoperatively and at the follow-up of 12,24 months postoperatively,and the excellent and good rate according to MacNab standard between the two groups(P>0.05).PELD group showed more advantageous in hospital stay and rework time,but OLMD group had lower reoperation rate(P<0.05).Conclusions Compared with OLMD,PELD in the treatment of single-segmental LDH has the advantages of less surgical injury,which is more beneficial to patients'postoperative rapid recovery.OLMD has the characteristics of lower reoperation rate.System review demonstrates that PELD procedure has smaller incision,but there existed a certain learning curve.The choice of OLMD procedure would receive less radiation.More high-quality clinical evidences are needed to support whether PELD can replace OLMD as the"gold standard"for treating LDH in clinic.
作者
李良生
林山
芮钢
胡宝山
孙乃坤
谷旸
LI liangsheng;LIN Shan;RUI Gang;HU Baoshan;SUN Naikun;GU Yang(The Orthopedic Branch of Mindong Hospital Affiliated to Fujian Medical University,Ningde,Fujian 355000,China)
出处
《中国骨科临床与基础研究杂志》
2019年第3期138-150,共13页
Chinese Orthopaedic Journal of Clinical and Basic Research
基金
厦门市卫生局科研基金项目（3502Z20154003,3502Z20154002）
