单侧双通道与单通道脊柱内镜下双侧减压治疗腰椎管狭窄症疗效及安全性的Meta分析

A meta-analysis of clinical efficacy and safety of unilateral laminotomy for bilateral decompression between unilateral biportal endoscopy and uniportal endoscopy in treatment of lumbar spinal stenosis

目的通过Meta分析比较单侧双通道脊柱内镜下双侧减压(Unilateral biportal endoscopic discectomy,unilateral laminectomy bilateral decompression,UBE-ULBD)与单通道脊柱内镜下双侧减压(Percutaneous endoscopic unilateral laminotomy for bilateral decompression,PE-ULBD)治疗腰椎管狭窄症的临床疗效及安全性。方法通过PubMed、Web of Science、EMbase、中国知网、万方数据库、维普数据库检索比较UBE-ULBD手术与PE-ULBD手术治疗腰椎管狭窄症安全性与疗效的文献,采用Review Manager 5.3软件进行Meta分析。比较UBE-ULBD组与PE-ULBD组手术时间、术中出血量、术后并发症发生率、术后下肢疼痛VAS评分、术后ODI指数、术后硬脊膜扩张面积。结果纳入6篇文献,其中队列研究5篇(高质量),随机对照试验研究1篇(低质量)。纳入329例,UBE-ULBD组170例,PE-ULBD组159例。两组手术时间、术中出血量、术后下肢疼痛VAS评分、术后并发症发生率、术后12个月ODI指数差异无统计学意义(P>0.05)。UBE-ULBD组术后3个月ODI指数低于PE-UBLD组,术后硬脊膜扩张面积大于PE-ULBD组,差异有统计学意义(P<0.05)。结论UBE-ULBD手术与PE-ULBD手术治疗腰椎管狭窄症的疗效相似,UBE-ULBD更适用于治疗双侧侧隐窝或存在中央椎管狭窄的患者,术中能提供更大的视野范围,进而获得更好的减压效果,而且安全性较高。

Objective To compare the clinical efficacy and safety of unilateral laminotomy for bilateral decompression between unilateral biportal endoscopy(UBE-ULBD)and uniportal endoscopy(PE-ULBD)in the treatment of lumbar spinal stenosis by Meta-analysis.Methods PubMed,Web of Science,EMbase,CNKI,Wanfang Database and VIP database were searched for studies comparing the safety and efficacy of UBE-ULBD surgery and PE-ULBD surgery for lumbar spinal stenosis.Review Manager 5.3 software was used for Meta-analysis.The operation time,intraoperative blood loss,postoperative complications,postoperative lower limb pain VAS score,postoperative ODI index and postoperative dural expansion area were compared between the UBE-ULBD group and the PE-ULBD group.Results A total of 6 articles were included,including 5 cohort studies(high quality)and 1 randomized controlled trial study(low quality).A total of 329 patients were enrolled,including 170 patients in the UBE-ULBD group and 159 patients in the PE-ULBD group.There was no significant difference in operation time,intraoperative blood loss,VAS score of lower limb pain after operation,incidence of postoperative complications,and ODI index at 12 months after operation between the two groups(P>0.05).The ODI index at 3 months after operation of UBE-ULBD group was lower than that of PE-UBLD group,and the expansion area of dura after operation of PE-ULBD group was larger than that of PE-ULBD group(P<0.05).Conclusion The efficacy of UBE-ULBD is similar to PE-ULBD in the treatment of lumbar spinal stenosis.UBE-ULBD is more suitable for the treatment of bilateral recess or central spinal stenosis.UBE-ULBD can provide a larger intraoperative field of view,thus achieving better decompression effect and high safety.