经皮椎间孔镜与椎间盘镜下手术治疗腰椎间盘突出症效果比较的Meta分析

A Meta-Analysis of Percutaneous Endoscopic Lumbar Discectomy Versus Micro Endoscopic Discectomy for Treatment of Lumbar Disc Herniation

目的:系统分析并比较经皮椎间孔镜手术(PELD)与椎间盘镜手术(MED)治疗腰椎间盘突出症的效果。方法:计算机检索中国期刊全文数据库(CNKI)、中国生物医学数据库(CBM)、万方、维普期刊网、the Cochrane Central Register of Controlled Trials(CEN-TRAL),PubMed,EMbase,Elsevier数据库,检索国内外公开发表的治疗单阶段腰椎间盘突出症的中/英文文献,检索时间均为建库至2016年8月20日,收集关于PELD和MED治疗腰椎间盘突出症的随机对照试验。根据纳入与排除标准独立进行文献检索、质量评价和资料提取后,应用Rev-Man 5.2软件进行Meta分析。结果:最终纳入4篇文献,共379例受试者,其中男218例,女161例;PELD组202例,MED组177例。Meta分析结果显示:与MED组相比,PELD组术中出血量少(MD=-59.00,95%CI(-88.07,-29.92),P <0.00 001),术后下地时间早(MD=-5.02,95%CI(-5.20,-4.83),P<0.000 01),手术时间长(MD=16.99,95%CI(5.99,27.99),P<0.000 01),差异有统计学意义;术后VSA评分(SMD=0.04,95%CI(-0.20,0.28),P=0.76)及JOA评分(SMD=0.20,95%CI(-0.12,0.52),P=0.22)两组比较差异无统计学意义。结论:PELD和MED都是腰椎间盘突出症的有效治疗方式,PELD较MED对组织损伤更小,出血量更少,术后恢复更快,更具有微创优势,但其学习曲线更长。

Objective:To systematically compare and evaluate the effectiveness between percutaneous endoscopic lumbar discectomy and micro endoscopic discectomy in treatment of lumbar disc herniation.Methods:Cochrane Library,Pub Med,PubMed,EMbase,Elsevier,the China Biological Medicine Database,CNKI,VIP and Wanfang Database were searched for articles published from the building of data base up to August 20,2016.Randomized controlled trials of percutaneous endoscopic lumbar discectomy and micro endoscopy discectomy in treatment of lumbar disc herniation were collected.The eligible trials were extracted according to the inclusion and exclusion criteria.The Rev-Man 5.2 software was used for data analysis.Results:A total of 4 RCTs involving 379 patients were included,218 cases in male and 161 cases in female,202 PELD cases and 177 MED cases were enrolled.The results of Meta-analysis showed that when compared with MED,PELD entailed less intra-operative blood loss(MD=-59.00,95%CI(-88.07,-29.92),P<0.000 01),earlier walk time after operation(MD=-5.02,95%CI(-5.20,-4.83),P<0.000 01),longer operation time(MD=16.99,95%CI(5.99,27.99),P<0.000 01),there were significant sifferences and there were no significant differences in VAS(SMD=0.04,95%CI(-0.20,0.28),P=0.76)and JOA(SMD=0.20,95%CI(-0.12,0.52),P=0.22)after operation.Conclusion:The Meta-analysis shows that PELD and MED are both effective in treating lumbar disc herniation.PELD has less injury,less intra-operative blood loss,faster postoperative recovery,more minimally invasive,but longer learning curve.