摘要
背景:显微椎间盘切除与显微内窥镜下椎间盘切除是两种安全有效的椎间盘手术方式,目前关于两种显微技术间的比较研究较少,各研究得出的结论不太一致。目的:通过Meta分析比较显微椎间盘切除与显微内窥镜下椎间盘切除治疗椎间盘突出症的安全性和有效性。方法:检索Cochrane Library、PubMed、CNKI、VIP、Web of Science、万方等数据库,时间限制均为建库到2013年11月;并手工检索相关杂志,收集显微椎间盘切除和显微内窥镜下椎间盘切除治疗腰椎间盘突出症的随机对照试验,对纳入研究按RevMan 5.2软件内条目进行质量评价,进行Meta分析。结果与结论:共纳入5个随机对照试验,共1 430例患者。Meta分析结果显示:在住院时间[MD=-0.19(-0.43,0.05),P=0.13]、Oswestry功能障碍指数改善率[MD=2.78(-0.15,5.72),P=0.06]、目测类比评分改善率[MD=1.96(-0.29,4.21),P=0.09]、神经根损伤方面[RR=0.20(0.03,1.12),P=0.07],两种治疗方式差异无显著性意义。与显微内窥镜下椎间盘切除相比,显微椎间盘切除手术时间短[MD=-10.13(-14.06,-6.21),P<0.000 01],术中出血量少[MD=-24.27(-39.45,-9.08),P=0.002],硬脊膜撕裂发生率低[RR=0.28(0.11,0.68),P=0.005],复发率低[RR=0.34(0.14,0.83),P=0.02]。提示目前在相同条件下显微椎间盘切除治疗椎间盘突出症更为安全有效,但是随着技术及设备的更新上述结论不一定永远不变,建议临床医生根据实际情况选择治疗方式。该课题尚需更多高质量的随机对照试验验证,同时应及时更新。
BACKGROUND：Microsurgical discectomy and microendoscopic discectomy are effective safe methods for treatment of lumbar disc herniations. Currently, the comparative study on two kinds of microtechnology was less, and the conclusion of each study is different.
OBJECTIVE：To compare the safety and effectiveness between microsurgical discectomy and microendoscopic discectomy for treatment of lumbar disc herniations using meta-analysis. METHODS：Cochrane Library, PubMed, CNKI, VIP, Web of Science and Wanfang were searched for articles published from building to November 2013. Related journals were retrieved by hand. Randomized control ed trials of microsurgical discectomy and microendoscopic discectomy for treatment of lumbar disc herniations were col ected. Qualities of included studies were evaluated using RevMan 5.2 software, and then analyzed by meta-analysis. RESULTS AND CONCLUSION：A total of 5 randomized control ed trials involving 1 430 cases were included. The results of meta-analysis indicated that no significant difference between microsurgical discectomy and microendoscopic discectomy groups was detected in the length of hospital stay [MD=-0.19 （-0.43, 0.05）, P=0.13], the improvement rate of Oswestry disability index [MD=2.78 （-0.15, 5.72）, P=0.06], the improvement rate of visual analogue scale [MD=1.96 （-0.29, 4.21）, P=0.09] and the root injure [RR=0.20 （0.03, 1.12）, P=0.07]. Compared with microendoscopic discectomy, microsurgical discectomy showed less surgical time [MD=-10.13 （-14.06,-6.21）, P〈0.000 01], less blood loss [MD=-24.27 （-39.45,-9.08）, P=0.002], lower incidence of dural tear [RR=0.28（0.11, 0.68）, P=0.005], lower risk of recurrent herniation [RR=0.34 （0.14, 0.83）, P=0.02]. Above data showed that microsurgical discectomy for lumbar disc herniations was safe and effective under the same condition, but with updated technology and equipment, above conclusion is not necessarily always the same. We suggested that clinical physicians should choose a manner based
出处
《中国组织工程研究》
CAS
CSCD
2014年第31期5036-5043,共8页
Chinese Journal of Tissue Engineering Research
