TF-PELD与IL-PELD治疗高髂嵴L_(5)-S_(1)椎间盘突出症的Meta分析

TF-PELD and IL-PELD in the treatment of high iliac crest L_(5)/S_(1) disc herniation:a Meta analysis

目的运用Meta分析研究椎间孔入路(transforaminal percutaneous endoscopic lumbar discectomy,TF-PELD)和椎板间入路(interlaminar percutaneous endoscopic lumbar discectomy,IL-PELD)治疗高髂嵴L_(5)-S_(1)椎间盘突出症的疗效。方法检索Cochrane图书馆、MEDLINE、EMBASE、PUBMED、中国生物医学文献数据库、中国期刊全文数据库、维普数据库、万方数据资料系统。观察的结局指标包括:手术时间、术中透视次数、术中出血量;视觉模拟评分法(visual analogue scale,VAS)、Oswestry功能障碍指数评分标准(oswestry disability index,ODI)、改良Macnab疗效评定标准、日本骨科协会评估治疗评分(Japanese Orthopaedic Association Scores,JOA)、并发症、复发情况。采用RevMan 5.3软件对所需数据进行整合统计分析与异质性分析。结果共纳入16篇文献,包括1054例患者,其中TF-PELD组525例患者,IL-PELD组529例患者。分析结果显示,手术时间、术中透视时间、术中出血量、术后48 h内VAS评分的差异有统计学意义(P<0.05),其余术后VAS评分、ODI评分、改良Macnab评分、JOA评分、并发症、复发情况等指标无统计学意义(P>0.05)。结论TF-PELD和IL-PELD治疗高髂嵴L 5-S 1腰椎间盘突出症术后疗效相当,并发症与复发程度无明显差异。但IL-PELD手术时间较短,术中透视次数及术中出血量较少。因此,对于高髂嵴L_(5)-S_(1)腰椎间盘突出症患者推荐使用IL-PELD手术。但IL-PELD对术者的技术操作要求较高,需要熟练掌握手术操作。

Objective To study the effect of transforaminal percutaneous endoscopic lumbar discectomy(TF-PELD)and interlaminar percutaneous endoscopic lumbar discectomy(IL-PELD)on high iliac crest L_(5)-S_(1) disc herniation by using meta-analysis.Methods Cochrane Library,MEDLINE,EMBASE,PUBMED,Chinese Biomedical Literature Database,Chinese Journal Full-text Database,Veep Database,Wanfang Data System were searched.Outcome measures were:operative time,number of intraoperative fluoroscopy,intraoperative bleeding,visual analog scale(VAS),Oswestry dysfunction index(ODI),modified Macnab efficacy assessment,Japanese Orthopaedic Association(JOA)scores,complications,recurrence.RevMan 5.3 software was used for integrated statistical analysis and heterogeneity analysis of the required data.Results A total of 16 articles were included,including 1054 patients,including 525 patients in TF-PELD group and 529 patients in IL-PELD group.The results showed that there were statistically significant differences in surgical time,intraoperative fluoroscopy time,intraoperative bleeding volume,and VAS scores within 48 h after surgery(P<0.05).The other postoperative VAS scores,ODI scores,modified Macnab scores,JOA scores,complications and recurrence had no statistically significant differences(P>0.05).Conclusion s The postoperative efficacy of TF-PELD and IL-PELD in the treatment of high iliac crest L_(5)-S_(1) lumbar disc herniation is comparable,complications and recurrence degree is not significantly different.But the IL-PELD operation time is shorter,the number of intraoperative fluoroscopy and the amount of intraoperative bleeding are less.Therefore,for patients with high iliac crest L_(5)-S_(1)lumbar disc herniation,we recommend the use of IL-PELD surgical methods.However,IL-PELD has higher requirements for the technical operation of the operator,so it needs to master the operation skillfully.