单侧双通道内镜与通道显微内镜治疗腰椎管狭窄症的meta分析

Efficacy and safety of unilateral biportal endoscopy versus tubular microendoscopic for lumbar spinal stenosis:A systematic review and meta-analysis

目的通过Meta分析比较单侧双通道内镜手术(UBES)与通道显微内镜手术(TMS)安全性及有效性的差异。方法计算机检索在Embase、Pubmed、Central、Cinahl、PQDT、Cochrane Library、CBM、CNKI等数据库公开发表的单侧双通道内镜手术和显微内镜手术治疗腰椎管狭窄症的文献,依据检索策略,共检索到相关文献784篇,并最终纳入14篇文献。对文献依据Cochrane系统评价方法学进行质量评价,提取数据后,用RevMan 5.4软件进行Meta分析。结果通过比较发现,UBES治疗腰椎管狭窄症时,在术后VAS下肢痛评分在术后1周内[95%CI:-1.05,-0.37,P<0.001]、术后VAS腰痛评分在术后1周内[95%CI:-1.77,-1.14,P<0.001]、术后ODI评分在术后1~3月[95%CI:-2.06,-0.05,P=0.04]、术后离床活动时间[95%CI:-12.09,-6.43,P<0.001]、住院时间[95%CI:-6.63,-1.09,P=0.006]、术中出血量[95%CI:-112.12,-36.37,P<0.001]及术后优良率(改良Macnab标准)[95%CI:1.05,3.46,P=0.04]评定上均优于TMS组。而两组手术方式在术后1周~1个月、术后1~3个月的下肢痛VAS评分和腰痛VAS评分,术后1月内ODI评分,手术时间及术后总并发症的结果差异均无统计学意义。结论在治疗腰椎管狭窄时,相较于TMS组,UBES组术后具有更短的住院时间、更早的离床活动时间、更少的出血量及更优的疼痛症状改善。

Objective This meta-analysis compared the safety and efficacy of unilateral biportal endoscopic surgery(UBES)and tubular microendoscopic surgery(TMS).Methods Computer searches were performed on Embase,PubMed,Central,Cochrane Library,CNKI,and Wanfang databases for published literature on UBES and TMS in lumbar spinal stenosis.A total of 784 related studies were retrieved,and 14 were finally included.Literature quality was evaluated using the Cochrane systematic review methodology.After data extraction,a meta-analysis was performed using the ReviewManager 5.4 software.Results By comparison,UBES for lumbar spinal stenosis was found to be associated with postoperative VAS lower extremity pain scores at 1 week postoperatively[95%CI:-1.05,-0.37,P<0.001],postoperative VAS low back pain scores at 1 week postoperatively[95%CI:-1.77,-1.14,P<0.001],postoperative ODI scores at 1-3 months postoperatively[95%CI:-2.06,-0.05,P=0.04],postoperative time out of bed[95%CI:-12.09,-6.43,P<0.001],hospital stay[95%CI:-6.63,-1.09,P=0.006],intraoperative bleeding[95%CI:-112.12,-36.37,P<0.001]and postoperative excellent rate(modified Macnab criteria)[95%CI:1.05,3.46,P=0.04]were rated better than the TMS group.In contrast,there was no significant difference between the two surgical approaches in the outcomes of lower extremity pain VAS scores and low back pain VAS scores at 1 week to 1 month and 1 to 3 months post-surgery,ODI scores at 1 month post-surgery,time to surgery and total post-surgery complications.Conclusion In the treatment of lumbar stenosis,the UBES group had a shorter hospital stay,an earlier time out of bed,less bleeding,and a better improvement in pain symptoms than the TMS group.