椎间盘镜与传统开放术治疗腰椎间盘突出症疗效和安全性比较的Meta分析

目的:比较椎间盘镜与传统开放椎间盘摘除术治疗腰椎间盘突出症的疗效与安全性。方法:在中国生物医药数据库,CNKI数据库,重庆VIP数据库和万方数据库进行系统文献检索。Meta统计分析使用RevMan4.2软件完成。对两种手术方法的优良率、手术时间、术中失血量、术后卧床休息时间、恢复日常活动时间、住院或手术后住院天数,以及并发症进行比较。结果:总共纳入了20篇文献,其中2957例患者行椎间盘镜术,而2130例患者行传统开放椎间盘摘除术。有12篇报道比较了两种治疗方法的手术时间,11篇比较了术中失血量,7篇比较了术后卧床休息时间,5篇进行了术后恢复日常活动所需时间的比较,另外分别有4篇比较了住院日及术后住院天数。其中有10篇文献提到了手术并发症。与开放手术比较,椎间盘镜治疗的患者有较高的优良率OR=1.29,95%CI(1.03,1.62)],术中出血量少OR=-63.67,95%CI(-86.78,-40.55)],更少的卧床休息时间OR=-15.33,95%CI(-17.76,-12.90)],恢复日常活动所需时间更短OR=-24.41,95%CI(-36.86,-11.96)],更少住院日OR=-5.00,95%CI(-6.94,-3.06)]或手术后住院天数OR=-7.47,95%CI(-9.17,-5.77)]。但是在手术并发症发生率和手术时间方面,两者之间差异无统计学意义。结论:椎间盘镜与传统开放术治疗腰椎间盘突出症均是安全有效的,手术并发症发生率相当。与传统手术比较,椎间盘镜治疗出血量少,术后卧床休息天数及住院日短,并且能更快地恢复日常生活。选择哪种手术方式主要根据患者的适应证,在相同适应证的情况下椎间盘镜手术应该被推荐。

Therapeutic effect and safety of microendoscopic discectomy versus conventional open discectomy for the treatment of lumbar disc herniation:a Meta-analysis

Objective: To conduct a meta-analysis of studies comparing theapeutic effect and safety of microendoscopic discectomy to conventional open discectomy in the treatment of lumbar disc herniation in China. Methods: A systematic literature retrieval was conducted in the Chinese Bio-medicine Database,CNKI database,Chongqin VIP database and Wangfang database. The statistical analysis was performed using a RevMan 4.2 software. The comparison included excellent rate,operation times,blood loss,periods of bed rest and resuming daily activities,hospital stay or hospital stay after surgery,and complications of microendoscopic discectomy versus conventional open discectomy. Results: The search yielded 20 reports,which included 2 957 cases treated by microendoscopic discectomy and 2 130 cases treated by conventional open discectomy. There were 12,11,7,5,4 and 4 reports which had comparison of operation times,blood loss,period of bed rest,periods of resuming daily activities,hospital stay and hospital stay after surgery respectively. Complications were mentioned in 10 reports. Compared to patients treated by open discectomy,patients treated by microendoscopic discectomy had a higher excellent rates OR=1.29,95%CI(1.03,1.62)],less blood lossOR=-63.67,95%CI(-86.78,-40.55)],less period of bed restOR=-15.33,95%CI(-17.76,-12.90)],less period of resumption of daily activities OR=-24.41,95%CI(-36.86,-11.96)],less hospital stay OR=-5.00,95%CI(-6.94,-3.06)] or hospital stay after surgery OR=-7.47,95%CI(-9.17,-5.77) respectively. However,incidence of complications and operation times were proved no significant different between microendoscopic discectomy and open discectomy. Conclusion: Microendoscopic discectomy and conventional open discectomy in treatment of lumbar disc herniation are both safe,effective;incidence of complications are nearly. Patients with lumbar disc herniation treated by microendoscopic discectomy have fewer blood loss,shorter periods of bed rest and hospital stay,and resume daily activities faster. Techniques are selected according to indications,microendoscopic discectomy should be carried out when conjunct indications occur.