椎间孔镜与椎间盘镜治疗腰椎间盘突出症后复发率及翻修率比较的Meta分析

Meta-analysis of the recurrence and revision rates of lumbar disc herniation treated by percutaneous transforaminal discectomy and microendoscopic discectomy

目的从复发率和翻修率方面对比当下较热门的椎间孔镜(PTED)与椎间盘镜(MED)对腰椎间盘突出症(LDH)的临床疗效。方法通过计算机检索PubMed、EMBASE、Cochrane Library、Ovid、中国知网和万方数据库6个数据库,收集所有关于PTED与MED在治疗LDH方面有关复发及翻修的高质量文献,对数据进行分类提取后,录入Review Manager 5.2软件,进行整理、分析,最后对所得结果进行敏感性分析及发表偏倚分析。结果此次Meta分析纳入12项研究共2400例患者。PTED与MED相比,其术后复发率高(OR=1.60,95%CI:1.01~2.53)和术后翻修率高(OR=1.77,95%CI:1.18~2.64)。结论尽管PTED具有术中出血少、术后恢复快等微创优点,但其复发率及翻修率均高于MED,目前尚不能盲目地考虑用PTED完全替代MED。

Objective Due to recent developments and the wide application of percutaneous transforaminal discectomy(PTED)in China,we herein compare the clinical effects of it with microendoscopic discectomy(MED),in terms of recurrence and revision rates.Methods 6 databases including PubMed,EMBASE,Cochrane Library,Ovid,CNKI and Wanfang were searched by computer,and the literatures were screened according to inclusion and exclusion criteria,and the quality of the included literatures was evaluated.After extracting the data in the paper,the Review Manager 5.2 software was applied to analyze the data.Finally,the sensitivity analysis and publication bias analysis of the results were conducted.Results 12 studies including 2,400 patients were included in this metaanalysis.Compared PTED with MED,postoperative recurrence rate and postoperative revision rate of PTED are high(OR=1.60,95%CI:1.01~2.53),(OR=1.77,95%CI:1.18~2.64).Conclusion Although PTED has many minimally invasive advantages,such as less intraoperative bleeding and faster postoperative recovery,its recurrence rate and revision rate are higher than MED.So it is not possible to blindly consider the complete replacement of MED with PTED.