微创腰椎间盘切除术安全性的Meta分析

目的:探讨微创腰椎间盘切除术(显微镜下椎间盘切除术及内窥镜下椎间盘切除术)的安全性。方法:由两位作者独立检索1997年1月1日至2011年9月1日Pubmed数据库、Embase数据库、Cochrane CentralRegister of Controlled Trials、中国生物医学文献服务系统(SinoMed)和万方数据库,搜集关于成人腰椎单节段微创椎间盘切除术和开放椎间盘切除术治疗腰椎间盘突出症的前瞻性随机对照研究,语种不限。两位作者独立评估各研究的质量,且将各研究中的手术时间、术中和术后并发症、术中失血量等提取整理为电子基线表,并将这些研究的数据通过Revman 5.1.0软件进行Meta分析与综合。结果:共有6篇研究符合标准,共计773例患者被纳入分析。微创椎间盘切除术与开放椎间盘切除术比较:前者术中神经损伤与硬膜撕裂[OR=1.53,95%CI(0.79,2.96)]、术后椎间盘再次突出[OR=1.70,95%CI(0.77,3.79)]、术后脑脊液漏[OR=1.00,95%CI(0.38,2.68)]的发生率略高,但均无统计学差异(P>0.05);后者术后感染[OR=0.32,95%CI(0.07,1.35)]的发生率略高于前者,亦无统计学差异(P>0.05);前者的手术时间长于后者[MD=18.03,95%CI(5.84,30.22)],术中失血量少于后者[MD=-62.65,95%CI(-102.56,-22.73)],差异有统计学意义(P<0.05)。结论:与开放腰椎间盘切除术比较,微创椎间盘切除术失血更少,但是手术耗时更长;两者的并发症发生率无统计学差异。

Safety of minimally invasive lumbar discectomy: a meta-analysis

Objectives:To determine if the use of minimally invasive technique(including microendoscopic discectomy and microscopic discectomy) decreases safety.Methods:The Pubmed databases,Embase databases,the Cochrane Central Register of Controlled Trials,SinoMed databases and Wanfang Data(from 1997-01-01 to 2011-09-01),and also the reference lists of relevant reviews for eligible studies were searched.Rrandomized control trials comparing one-level microendoscopic discectomy and open discectomy in adults worldwide with prospective data collection.Two authors independently assessed trial quality and extracted data into an electrical sheet.Data of operation time,complications and blood loss from these studies were abstracted and synthesized by a meta-analysis with Revman 5.1.0.Results:6 trials involving 773 adults metting our criteria were included for analysis.Comparing minimally invasive discectomy and open discectomy,the former was more likely to increase intraoperation complications[OR=1.53,95%CI(0.79,2.96)],have higher risk of recurrent herniation[OR=1.70,95%CI(0.77,3.79)] and dural tears[OR=1.00,95%CI(0.38,2.68)].And the latter had higher risk of postoperation infection[OR=0.32,95%CI(0.07,1.35)],but all of these complications had no statistical difference(P>0.05).The minimally invasive surgery spent more operation time[MD=18.03,95%CI(5.84,30.22)] with less blood loss[MD=-62.65,95%CI(-102.56,-22.73)],and both had statistical differences(P<0.05).Conclusions:Compared with open discectomy,the minimally invasive surgery entails longer operation time and less blood loss,the rates of complications have no statistical difference.