不同手术方式治疗腰椎间盘突出症疗效的网状Meta分析

Efficacy of different surgical procedures for treatment of lumbar disc herniation: a network Meta-analysis

目的比较传统开放椎间盘切除术(SOD)、后路显微内窥镜下椎间盘切除术(MED)、经皮内窥镜下椎间盘切除术(PELD)治疗腰椎间盘突出症的效果。方法计算机检索中国知网、万方、维普、Pub Med、Embase、Cochrane Library等数据库,筛选关于SOD、后路MED、PELD治疗腰椎间盘突出症的临床研究。筛选文献后进行文献质量评价。应用R软件和Stata软件进行网状Meta分析。结果纳入16篇文献,共1288例患者。网状Meta分析结果显示,后路MED、PELD、SOD的术后近期视觉模拟量表(VAS)疼痛评分依次升高(均P<0.05);PELD、后路MED、SOD术后远期VAS评分依次升高,其中PELD术后近期VAS评分明显低于SOD(均P<0.05)。结论对于腰椎间盘突出症患者,PELD和后路MED术后疼痛缓解效果均优于SOD,从术后长期的、稳定的疼痛指数考虑,PELD是最佳选择。

Objective To compare the efficacy among standard open discectomy(SOD),posterior microendoscopic discectomy(MED)and percutaneous endoscopic lumbar discectomy(PELD)for the treatment of lumbar disc herniation.Methods A computer-based retrieval was conducted in the databases of CNKI,Wanfang,VIP,PubMed,Embase and Cochrane library to screen out the clinical trials on lumbar disc herniation treated by SOD,posterior MED or PELD.Literature screening was carried out prior to the assessment on quality of literature.R software and Stata software were applied to network Meta-analysis.Results Sixteen trials were included involving1288 patients.The results of network Meta-analysis showed that the short-term Visual Analogue Scale(VAS)scores for postoperative pain of posterior MED,PELD,and SOD increased in turn(all P<0.05);the postoperative long-term VAS scores of PELD,posterior MED,and SOD increased in turn,and PELD exhibited significantly lower postoperative short-term VAS scores than SOD(all P<0.05).Conclusion For patients with lumbar disc herniation,PELD and posterior MED both achieve superior efficacy for ameliorating postoperative pain as compared with SOD,and PELD is the optimal choice in view of stable postoperative pain index in the long term.