目的:通过Meta分析对比单通道内镜及单侧双通道内镜(UBE)在治疗腰椎管狭窄症的临床疗效。方法:检索PubMed、Cochrane Library、Embase和Web of Science等数据库(从建库到2023年10月)对单通道内镜和单侧双通道内镜治疗腰椎管狭窄症疗效...目的:通过Meta分析对比单通道内镜及单侧双通道内镜(UBE)在治疗腰椎管狭窄症的临床疗效。方法:检索PubMed、Cochrane Library、Embase和Web of Science等数据库(从建库到2023年10月)对单通道内镜和单侧双通道内镜治疗腰椎管狭窄症疗效的临床研究进行检索。提取纳入研究的结局指标,包括:腰部和腿部疼痛的VAS评分、术后ODI评分、手术时间、住院天数、并发症发生率、手术优良率。使用Revman 5.3软件对数据进行统计学分析,单个率采用优势比(odds ratios, OR),连续性变量采用加权平均差异(weighted mean difference, WMD),并给出可信区间(confidence interval, CI)为95%。结果:总共有6项研究,515名患者被纳入该Meta分析。UBE手术相对于单通道内镜有着更短的手术时间(WMD −12.37, 95%CI −22.15~−2.6, P = 0.01)。两组患者在腰痛VAS评分[术后第一天(WMD 0.27, 95%CI −0.29~0.82, P = 0.35)、末次随访(WMD −0.02, 95%CI −0.1~0.06, P = 0.63)]、腿痛VAS评分[术后第一天(WMD −0.17, 95%CI −0.43~0.09, P = 0.20)、末次随访(WMD 0.03, 95%CI −0.15~0.15, P = 0.51)、ODI评分(WMD −0.1, 95%CI −0.67~0.47, P = 0.73)、并发症(OR 0.72, 95%CI 0.37~1.41, P = 0.34)、住院天数(WMD −0.06, 95%CI −0.27~0.15, P = 0.56)、手术优良率(OR 1.32, 95%CI 0.69~2.53, P = 0.56)等方面均无明显差异。结论:UBE和单通道内镜治疗腰椎管狭窄症的临床疗效和并发症发生率无明显差异。而UBE与单通道内镜组相比有着更短的手术时间。Objective: To compare the clinical efficacy of uniportal endoscoppic and biportal endoscopic (UBE) decompression for the treatment of lumbar spinal stenosis through meta-analysis. Methods: PubMed, Cochrane Library, Embase and Web of Science databases were searched (from the establishment of the database to October 2023) to compare the clinical studies on the clinical efficacy of uniportal and biportal endoscopy in the treatment of lumbar spinal stenosis. The outcome indicators included in the study were extracted, including VAS score of lumbar and leg pain, postoperative ODI score, operation time, length of hospital stay, complication rate, and surgical excellence rate. Statistical analysis was performed using Revman 5.3 software. A fixed or random effects model was used with odds ratios (OR) for single rate and weighted mean difference (WMD) for continuous variables, and confidence intervals CI was 95%. Results: A total of 6 studies with 515 patients were included in this meta-analysis. Compared with uniportal endoscopy, UBE surgery had a shorter operation time (WMD −12.37, 95%CI −22.15~2.6, P = 0.01). There was no significant difference between groups in VAS scores for low back pain (first day after surgery (WMD 0.27, 95%CI 0.29~0.82, P = 0.35), final follow-up (WMD −0.02, 95%CI 0.1~0.06, P = 0.63), and leg pain first day after surgery (WMD −0.17, 95%CI −0.43~0.09, P = 0.20), final follow-up (WMD 0.03, 95%CI −0.15~0.15, P = 0.51), ODI score (WMD −0.1, 95%CI −0.67~0.47, P = 0.73), complications (OR 0.72, 95%CI 0.37~1.41, P = 0.34), length of hospital stay (WMD −0.06, 95%CI 0.27~0.15, P = 0.56), and rate of excellent operation (OR 1.32, 95%CI 0.69~2.53, P = 0.56). Conclusion: There is no significant difference in clinical efficacy and complication rate between UBE and single channel endoscopy in the treatment of lumbar stenosis. Compared with the single channel endoscopic group, UBE has a shorter operation time.展开更多
目的:观察单通道脊柱内镜技术治疗极外侧椎间盘突出症(extraforaminal disk herniations,EFDHs)患者的临床效果和安全性。方法:回顾性分析接受单通道脊柱内镜治疗的21例极外侧椎间盘突出症患者的临床资料,其中5例合并椎间孔轻度狭窄,对...目的:观察单通道脊柱内镜技术治疗极外侧椎间盘突出症(extraforaminal disk herniations,EFDHs)患者的临床效果和安全性。方法:回顾性分析接受单通道脊柱内镜治疗的21例极外侧椎间盘突出症患者的临床资料,其中5例合并椎间孔轻度狭窄,对于合并椎间孔狭窄患者采用镜下可视环锯技术及镜下动力磨钻技术行腰椎间孔扩大成形。术前、术后1、3、6个月及1年采用视觉模拟评分法(visual analogue scale,VAS)评估患者腰腿疼痛程度,采用Oswestry功能障碍指数(Oswestry Disability Index,ODI)评估患者腰椎功能,末次随访时采用改良MacNab标准评价手术疗效。结果:术前疼痛VAS评分为7.14±1.11分,术后1、3、6个月及1年VAS评分依次递降,分别为2.67±0.86分、2.33±0.80分、1.67±0.80分及1.43±0.93分,均较术前显著降低,差异均有统计学意义(P<0.01)。术前ODI评分为65.64±4.67分,术后1、3、6个月及1年ODI评分依次递降,分别为34.24±3.85分、29.21±2.86分、24.42±4.17分及21.60±4.12分,均较术前显著降低,差异均有统计学意义(P<0.01)。末次随访时手术优良率为90.48%。结论:单通道脊柱内镜技术治疗极外侧椎间盘突出症可明显改善患者腰腿疼痛及腰椎功能,疗效高,安全性好。展开更多
目的:探讨Delta大通道内镜辅助下后路椎管减压椎间植骨融合术治疗退变性腰椎疾病的效果。方法:回顾性分析2021年9月~2022年9月我院收治的80例退变性腰椎疾病患者的病历资料,根据患者治疗方式分为观察组(38例,男17例,女21例,年龄61.0...目的:探讨Delta大通道内镜辅助下后路椎管减压椎间植骨融合术治疗退变性腰椎疾病的效果。方法:回顾性分析2021年9月~2022年9月我院收治的80例退变性腰椎疾病患者的病历资料,根据患者治疗方式分为观察组(38例,男17例,女21例,年龄61.0±4.9岁)和对照组(42例,男20例,女22例,年龄60.5±5.4岁),观察组患者采取Delta大通道内镜下Endo-PLIF治疗,对照组采取开放后路腰椎椎间融合术治疗,记录两组患者术中出血量、术后引流量、手术时间、手术切口长度、住院时间,比较患者并发症发生情况。于术前、术后1周、1个月、3个月、6个月使用视觉模拟量表(visual analogue scale,VAS)评分评估患者腰痛情况,并采用Oswestry功能障碍指数(Oswestry disability index,ODI)评估患者腰椎功能;使用改良Macnab标准对患者进行疗效评估。根据患者术后1年随访时的腰椎影像学复查结果,使用Bridwell椎间融合标准对患者手术节段融合情况进行评估。结果:观察组患者的术中出血量及术后引流量分别低于对照组(88.46±10.98mL vs 112.99±12.01mL、159.73±18.42mL vs 201.36±23.06mL,P<0.05),手术切口及住院时间分别短于对照组(1.54±0.36cm vs 5.43±1.01cm、6.79±1.22d vs 8.03±1.43d,P<0.05),手术时间长于对照组(162.33±19.57min vs 126.87±23.15min,P<0.05)。80例患者术后均获随访,随访时间15~40个月(19.0±6.3个月)。观察组患者术后1周、术后1个月的VAS评分分别为2.46±0.51分、1.21±0.38分,ODI分别为(17.84±4.15)%、(10.69±1.88)%,均低于对照组[VAS评分分别为3.68±0.62分、2.01±0.41分,ODI分别为(21.33±3.48)%、(12.33±2.17)%,均P<0.05],两组患者术后3个月、术后6个月的VAS评分比较无统计学差异(P>0.05)。观察组治疗优良率为92.11%,与对照组的85.71%比较无统计学意义(P=0.487)。两组患者融合分级比较,差异无统计学意义(Z=0.487,P=0.624)。观察组术后并发症发生率为5.26%,与对照组的9.52%比较无统计学差异(P=0.678)。结论:Delta大通道内镜辅助下后路椎管减压椎间植骨融合术治疗退变性腰椎疾病效果良好,可以减少术中出血量,缩短手术切口和住院时间,更快改善患者术后短期内疼痛、腰椎功能,安全性较好。展开更多
目的分析单侧双通道内镜与单通道内镜椎板间入路双侧椎管减压术(unilateral laminectomy for bilateral decompression,ULBD)治疗腰椎管狭窄症的疗效及影响因素。方法采取回顾性研究,收集2020年1月至2022年12月贵州省遵义市播州区人民...目的分析单侧双通道内镜与单通道内镜椎板间入路双侧椎管减压术(unilateral laminectomy for bilateral decompression,ULBD)治疗腰椎管狭窄症的疗效及影响因素。方法采取回顾性研究,收集2020年1月至2022年12月贵州省遵义市播州区人民医院收治的120例腰椎管狭窄症患者临床资料。按手术方式分为单侧双通道内镜ULBD术组(双通道组,n=51)和单侧单通道内镜ULBD术组(单通道组,n=69)。统计并比较两组患者术后3个月时MacNab标准评估的优良率;记录手术时间、术中出血量和住院时间;比较术前、术后3个月的VAS评分、JOA评分及ODI评分。并将腰椎管狭窄症患者术后按照临床疗效分为有效组、无效组,统计并比较两组的基线资料,采用Logistic回归分析造成腰椎管狭窄症患者术后治疗无效的危险因素。结果双通道组的优良率(84.31%)与单通道组(81.16%)比较,差异无统计学意义(P>0.05);双通道组的手术时间短于单通道组,两组间比较差异具有统计学意义(P<0.05);两组术中出血量比较,差异无统计学意义(P>0.05);双通道组的住院时间长于单通道组,两组间比较差异具有统计学意义(P<0.05)。术后3个月两组的VAS、ODI评分低于术前,JOA评分高于术前,差异有统计学意义(P<0.05);术后3个月的两组间的VAS、JOA、ODI评分比较,差异无统计学意义(P>0.05)。无效组年龄≥75岁,髓内信号为水肿型、囊变型,术前腰椎失稳,术前纤维环破裂患者占比高于有效组,病程相较于有效组长(P<0.05);建立二元Logistic回归模型,结果显示,年龄≥75岁,病程长,髓内信号为水肿型、囊变型,术前腰椎失稳,术前纤维环破裂是腰椎管狭窄症患者ULBD术治疗无效的危险因素(OR>1,P<0.05)。结论单侧双通道内镜与单通道内镜ULBD术对腰椎管狭窄症患者均有较好的治疗效果,其中双通道具有手术时间短的优势,同时年龄≥75岁,髓内信号为水肿型、囊变型,术前腰椎失稳,术前纤维环破裂是导致腰椎管狭窄症患者术后治疗效果较差的危险因素。展开更多
文摘目的:通过Meta分析对比单通道内镜及单侧双通道内镜(UBE)在治疗腰椎管狭窄症的临床疗效。方法:检索PubMed、Cochrane Library、Embase和Web of Science等数据库(从建库到2023年10月)对单通道内镜和单侧双通道内镜治疗腰椎管狭窄症疗效的临床研究进行检索。提取纳入研究的结局指标,包括:腰部和腿部疼痛的VAS评分、术后ODI评分、手术时间、住院天数、并发症发生率、手术优良率。使用Revman 5.3软件对数据进行统计学分析,单个率采用优势比(odds ratios, OR),连续性变量采用加权平均差异(weighted mean difference, WMD),并给出可信区间(confidence interval, CI)为95%。结果:总共有6项研究,515名患者被纳入该Meta分析。UBE手术相对于单通道内镜有着更短的手术时间(WMD −12.37, 95%CI −22.15~−2.6, P = 0.01)。两组患者在腰痛VAS评分[术后第一天(WMD 0.27, 95%CI −0.29~0.82, P = 0.35)、末次随访(WMD −0.02, 95%CI −0.1~0.06, P = 0.63)]、腿痛VAS评分[术后第一天(WMD −0.17, 95%CI −0.43~0.09, P = 0.20)、末次随访(WMD 0.03, 95%CI −0.15~0.15, P = 0.51)、ODI评分(WMD −0.1, 95%CI −0.67~0.47, P = 0.73)、并发症(OR 0.72, 95%CI 0.37~1.41, P = 0.34)、住院天数(WMD −0.06, 95%CI −0.27~0.15, P = 0.56)、手术优良率(OR 1.32, 95%CI 0.69~2.53, P = 0.56)等方面均无明显差异。结论:UBE和单通道内镜治疗腰椎管狭窄症的临床疗效和并发症发生率无明显差异。而UBE与单通道内镜组相比有着更短的手术时间。Objective: To compare the clinical efficacy of uniportal endoscoppic and biportal endoscopic (UBE) decompression for the treatment of lumbar spinal stenosis through meta-analysis. Methods: PubMed, Cochrane Library, Embase and Web of Science databases were searched (from the establishment of the database to October 2023) to compare the clinical studies on the clinical efficacy of uniportal and biportal endoscopy in the treatment of lumbar spinal stenosis. The outcome indicators included in the study were extracted, including VAS score of lumbar and leg pain, postoperative ODI score, operation time, length of hospital stay, complication rate, and surgical excellence rate. Statistical analysis was performed using Revman 5.3 software. A fixed or random effects model was used with odds ratios (OR) for single rate and weighted mean difference (WMD) for continuous variables, and confidence intervals CI was 95%. Results: A total of 6 studies with 515 patients were included in this meta-analysis. Compared with uniportal endoscopy, UBE surgery had a shorter operation time (WMD −12.37, 95%CI −22.15~2.6, P = 0.01). There was no significant difference between groups in VAS scores for low back pain (first day after surgery (WMD 0.27, 95%CI 0.29~0.82, P = 0.35), final follow-up (WMD −0.02, 95%CI 0.1~0.06, P = 0.63), and leg pain first day after surgery (WMD −0.17, 95%CI −0.43~0.09, P = 0.20), final follow-up (WMD 0.03, 95%CI −0.15~0.15, P = 0.51), ODI score (WMD −0.1, 95%CI −0.67~0.47, P = 0.73), complications (OR 0.72, 95%CI 0.37~1.41, P = 0.34), length of hospital stay (WMD −0.06, 95%CI 0.27~0.15, P = 0.56), and rate of excellent operation (OR 1.32, 95%CI 0.69~2.53, P = 0.56). Conclusion: There is no significant difference in clinical efficacy and complication rate between UBE and single channel endoscopy in the treatment of lumbar stenosis. Compared with the single channel endoscopic group, UBE has a shorter operation time.
文摘目的:探讨Delta大通道内镜辅助下后路椎管减压椎间植骨融合术治疗退变性腰椎疾病的效果。方法:回顾性分析2021年9月~2022年9月我院收治的80例退变性腰椎疾病患者的病历资料,根据患者治疗方式分为观察组(38例,男17例,女21例,年龄61.0±4.9岁)和对照组(42例,男20例,女22例,年龄60.5±5.4岁),观察组患者采取Delta大通道内镜下Endo-PLIF治疗,对照组采取开放后路腰椎椎间融合术治疗,记录两组患者术中出血量、术后引流量、手术时间、手术切口长度、住院时间,比较患者并发症发生情况。于术前、术后1周、1个月、3个月、6个月使用视觉模拟量表(visual analogue scale,VAS)评分评估患者腰痛情况,并采用Oswestry功能障碍指数(Oswestry disability index,ODI)评估患者腰椎功能;使用改良Macnab标准对患者进行疗效评估。根据患者术后1年随访时的腰椎影像学复查结果,使用Bridwell椎间融合标准对患者手术节段融合情况进行评估。结果:观察组患者的术中出血量及术后引流量分别低于对照组(88.46±10.98mL vs 112.99±12.01mL、159.73±18.42mL vs 201.36±23.06mL,P<0.05),手术切口及住院时间分别短于对照组(1.54±0.36cm vs 5.43±1.01cm、6.79±1.22d vs 8.03±1.43d,P<0.05),手术时间长于对照组(162.33±19.57min vs 126.87±23.15min,P<0.05)。80例患者术后均获随访,随访时间15~40个月(19.0±6.3个月)。观察组患者术后1周、术后1个月的VAS评分分别为2.46±0.51分、1.21±0.38分,ODI分别为(17.84±4.15)%、(10.69±1.88)%,均低于对照组[VAS评分分别为3.68±0.62分、2.01±0.41分,ODI分别为(21.33±3.48)%、(12.33±2.17)%,均P<0.05],两组患者术后3个月、术后6个月的VAS评分比较无统计学差异(P>0.05)。观察组治疗优良率为92.11%,与对照组的85.71%比较无统计学意义(P=0.487)。两组患者融合分级比较,差异无统计学意义(Z=0.487,P=0.624)。观察组术后并发症发生率为5.26%,与对照组的9.52%比较无统计学差异(P=0.678)。结论:Delta大通道内镜辅助下后路椎管减压椎间植骨融合术治疗退变性腰椎疾病效果良好,可以减少术中出血量,缩短手术切口和住院时间,更快改善患者术后短期内疼痛、腰椎功能,安全性较好。
文摘目的分析单侧双通道内镜与单通道内镜椎板间入路双侧椎管减压术(unilateral laminectomy for bilateral decompression,ULBD)治疗腰椎管狭窄症的疗效及影响因素。方法采取回顾性研究,收集2020年1月至2022年12月贵州省遵义市播州区人民医院收治的120例腰椎管狭窄症患者临床资料。按手术方式分为单侧双通道内镜ULBD术组(双通道组,n=51)和单侧单通道内镜ULBD术组(单通道组,n=69)。统计并比较两组患者术后3个月时MacNab标准评估的优良率;记录手术时间、术中出血量和住院时间;比较术前、术后3个月的VAS评分、JOA评分及ODI评分。并将腰椎管狭窄症患者术后按照临床疗效分为有效组、无效组,统计并比较两组的基线资料,采用Logistic回归分析造成腰椎管狭窄症患者术后治疗无效的危险因素。结果双通道组的优良率(84.31%)与单通道组(81.16%)比较,差异无统计学意义(P>0.05);双通道组的手术时间短于单通道组,两组间比较差异具有统计学意义(P<0.05);两组术中出血量比较,差异无统计学意义(P>0.05);双通道组的住院时间长于单通道组,两组间比较差异具有统计学意义(P<0.05)。术后3个月两组的VAS、ODI评分低于术前,JOA评分高于术前,差异有统计学意义(P<0.05);术后3个月的两组间的VAS、JOA、ODI评分比较,差异无统计学意义(P>0.05)。无效组年龄≥75岁,髓内信号为水肿型、囊变型,术前腰椎失稳,术前纤维环破裂患者占比高于有效组,病程相较于有效组长(P<0.05);建立二元Logistic回归模型,结果显示,年龄≥75岁,病程长,髓内信号为水肿型、囊变型,术前腰椎失稳,术前纤维环破裂是腰椎管狭窄症患者ULBD术治疗无效的危险因素(OR>1,P<0.05)。结论单侧双通道内镜与单通道内镜ULBD术对腰椎管狭窄症患者均有较好的治疗效果,其中双通道具有手术时间短的优势,同时年龄≥75岁,髓内信号为水肿型、囊变型,术前腰椎失稳,术前纤维环破裂是导致腰椎管狭窄症患者术后治疗效果较差的危险因素。
