微创与开放椎间盘切除术治疗腰椎椎间盘突出症的Meta分析

Minimally invasive versus open discectomy in treatment of lumbar disc: Meta analysis

目的对微创与开放椎间盘切除术治疗腰椎椎间盘突出症的临床疗效进行Meta分析。方法使用数据库和网上资源检索,再辅以手工检索,中文检索词选择"椎间盘突出症""微创""开放",英文检索词选择"minimally invasive discectomy""open discectomy""mircodiscectomy",纳入关于微创与开放手术治疗腰椎椎间盘突出症的前瞻性随机对照研究(RCT)文献。采用Jadad量表进行文献质量评价。数据的合并采用Review Manager 5.3软件。应用Gradepro软件对每项研究指标进行证据分级。主要提取的数据包括病例的基本特征、手术相关指标、随访时间、术后并发症、功能改善。结果经过检索筛选共纳入10篇文献,文献质量评价均为高质量RCT。两种手术方式在术中出血量、住院时间、术后感染等方面差异有统计学意义,微创手术优于开放手术;而在手术时间、术后下肢疼痛、术后Oswestry功能障碍指数(ODI)、术后腰部疼痛、术后并发症、术后复发等方面差异无统计学意义。结论微创手术的住院时间、术中出血量、术后感染优于开放手术,但总体疗效二者无显著差异。

Objective To analyze the clinical effect of the open and minimally invasive discectomy in the treatment of lumbar disc herniation using meta analysis. Methods Retrieveing the database and online resources,coupled with the manual retrieval,by using the keywords ：minimally invasive discectomy,open discectomy,the data of prospective RCTs（randomised controlled trials） about treatment of lumbar disc herniation with minimally invasive discectomy and open discectomy were collected. The Jadad scale was used to evaluate the risk of bias of the included studies. All data were analyzed by Review Manager 5.3 software. Gradepro software was used to study the evidence classification of indicators. Main extracted data included the basic characteristics of the cases,surgery related indicators,follow-up time,postoperative complications,and functional improvement. Results Ten studies were included,and literature quality evaluation indicated that all of included studies were of high quality of RCT. In the intraoperative blood loss,length of hospital stay,postoperative infection,the difference was statistically significant between the 2 groups,showed that minimally invasive surgery was superior to open surgery. In operation time,postoperative lower limb pain,postoperative Oswestry disability index（ODI）,postoperative lumbar pain,postoperative complications,postoperative recurrence there was no statistically significant difference between 2 kinds of operation method. Conclusion Compared with open discectomy,minimally invasive discectomy is better due to less blood loss,hospital stay,and postoperative infection. But there is no significant difference in overall effectiveness.