经皮完全内窥镜与显微内窥镜下后路颈椎间孔切开减压术围手术期并发症的Meta分析

Full-endoscopic versus microendoscopic posterior foraminotomy in the treatment of cervical radiculopathy:a Meta-analysis of perioperative complications

目的:系统分析经皮完全内窥镜(full-endoscopic,FE)与显微内窥镜(microendoscopic,MI)下后路颈椎间孔切开减压术(posterior cervical foraminotomy,PCF)治疗神经根型颈椎病围手术期并发症的发生率及特点。方法:计算机检索Pub Med、Embase、Web of Science以及中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)和万方数据库自建库至2017年10月通过FE-PCF或MI-PCF治疗椎间盘侧方突出或椎间孔狭窄引起的神经根型颈椎病的文献。两名研究人员独立进行文献筛选、质量评价和数据提取,并将相关文献报道的并发症分类汇总。采用Comprehensive Meta Analysis 2.2软件进行统计分析,选择发生率作为效应量指标,并计算其95%置信区间(confidence interval,CI)。结果:最终纳入28篇文献,共2060例患者;其中FE组410例,MI组1650例。FE组并发症总体发生率为5.7%(CI:3.4%~9.5%),MI组为3.5%(CI:2.7%~4.6%),二者无统计学差异(P=0.100);而并发症的构成比例则明显不同,FE组以短暂性神经根麻痹为主(15/19,78.9%),MI组常见的并发症依次为硬脊膜撕裂(20/48,41.7%)、短暂性神经根麻痹(11/48,22.9%)和浅表伤口感染(5/48,10.4%)。其中,短暂性神经根麻痹的发生率在FE组为4.4%(CI:2.8%~7.1%),显著高于MI组1.6%(CI:1.0%~2.6%),且差异具有统计学意义(P=0.003);硬脊膜撕裂发生率在FE组为1.6%(CI:0.7%~3.8%),MI组为1.8%(CI:1.2%~2.7%),无统计学差异(P=0.784)。结论:FE-PCF与MI-PCF治疗神经根型颈椎病均相对安全,二者间并发症总体发生率基本一致。然而,FE-PCF术后易出现短暂性神经根麻痹,值得广大临床医师关注。

Objectives： To systematically compare the incidence and constituent ratio of perioperative complications between full-endoscopic posterior cervical foraminotomy（FE-PCF） and microendoscopic posterior cervical foraminotomy（MI-PCF） in the treatment of cervical radiculopathy. Methods： An electronic retrieval from PubMed, Embase, Web of Science, China Biological Medicine Database（CBM）, China National Knowledge Infrastructure（CNKI） and Wanfang Database was performed for available literatures published before October 2017, concerning FE-PCF and MI-PCF for cervical radiculopathy due to lateral disc herniation or foraminal stenosis. Two researchers independently conducted inclusion of eligible studies, methodological quality assessment, data extraction, classification and summarizing of complications. Comprehensive Meta Analysis 2.2 was applied for statistical analysis, incidence of complications was calculated and reported with 95% confidence intervals （CI） reported. Results： A total of 28 studies with 2060 patients, including 410 of FE-PCF and 1650 of MI-PCF, was incorporated in this study. Overall complication rates were 5.7%（CI, 3.4%-9.5%） and 3.5%（CI, 2.7%-4.6%） for the FE and MI group, respectively, with no significant difference（P=0.100）. However, constituent ratio of complications showed apparent disparity with transient root palsy rated as first in the FE group（15/19, 78.9%）, while dural tear（20/48, 41.7%）, transient root palsy（11/48, 22.9%） and superficial wound infection （5/48, 10.4%） ranked in sequence as the top three in the MI group. In regard to subgroup analysis of individual complication, transient root palsy occurred at a higher incidence of 4.4%（CI, 2.8%-7.1%） in the FE group than 1.6%（CI, 1.0%-2.6%） in the MI group, which demonstrated statistical significance （P=0.003）, whereas dural tear rate of the FE group and the MI group showed no statistical difference（FE, 1.6%; MI, 1.8%; P=0.784）. Conclusions： Both FE-PCF and MI-PCF can offer safe treatment for cervical radiculopathy and there is no significant difference in overall complication rate between these two techniques. Nevertheless, transient root palsy after FE-PCF at a relatively higher incidence deserves extensive attention.