中国循证医学杂志

中国循证医学杂志

PELD 椎间孔入路与椎板间入路治疗 L5/S1 椎间盘突出症疗效和安全性的 Meta 分析

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目的系统评价经皮内镜下腰椎间盘切除术(percutaneous endoscopic lumbar discectomy,PELD)椎间孔入路(TF-PELD)与椎板间入路(IL-PELD)比较治疗 L5/S1 椎间盘突出症的疗效和安全性。方法计算机检索 PubMed、EMbase、The Cochrane Library、CBM、CNKI 和 WanFang Data 数据库,搜集关于 TF-PELD 和 IL-PELD 比较治疗 L5/S1 腰椎间盘突出症的随机对照试验和队列研究,检索时限均从建库至 2017 年 10 月。由 2 名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用 RevMan 5.3 软件进行 Meta 分析。结果共纳入 1 个随机对照试验和 7 个队列研究,包括 414 例患者。Meta 分析结果显示:与 IL-PELD 相比,TF-PELD 手术时间更长[MD=17.42,95%CI(12.86,21.97),P<0.000 01]、术中透视次数更多[MD=8.42,95%CI(6.18,10.65),P<0.000 01],但两组在术后随访 VAS 评分[MD=0.01,95%CI(–0.23,0.25),P=0.94]、术后随访 ODI 评分[MD=–0.46,95%CI(–2.42,1.49),P=0.64]、术后优良率[RR=1.00,95%CI(0.89,1.12),P=0.96]和并发症发生率[RR=0.73,95%CI(0.45,1.18),P=0.20]方面的差异均无统计学意义。结论当前证据表明,TF-PELD 和 IL-PELD 治疗 L5/S1 椎间盘突出症的疗效和安全性相当,但 IL-PELD 具有手术时间更短、术中射线暴露更少的优势。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

ObjectiveTo systematically review the efficacy and safety of percutaneous endoscopic lumbar discectomy (PELD) for L5/S1 disc herniation via transforaminal approach (TF-PELD) versus interlaminar approach (IL-PELD).MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) and the cohort studies of TF-PELD versus IL-PELD for L5/S1 disc herniation from inception to October 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 1 RCT and 7 cohort studies involving 414 patients were included. The results of meta-analysis indicated that: compared with IL-PELD group, TF-PELD group had longer operative time (MD=17.42, 95%CI 12.86 to 21.97, P<0.000 01) and more frequency of intraoperative fluoroscopy (MD=8.42, 95%CI 6.18 to 10.65,P<0.000 01), respectively. However, there were no significant differences between two groups in the post-operative visual analogue scale (MD=0.01, 95%CI –0.23 to 0.25,P=0.94), the post-operative Oswestry disability index (MD=–0.46, 95%CI –2.42 to 1.49, P=0.64), the excellent and good outcomes rate (RR=1.00, 95%CI 0.89 to 1.12, P=0.96), and the rate of complications (RR=0.73, 95%CI 0.45 to 1.18, P=0.20).ConclusionCurrent evidence shows that TF-PELD and IL-PELD are equally effective and safe for L5/S1 disc herniation, but IL-PELD is superior to TF-PELD in less operative time and less radiation exposure. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.

关键词: 腰椎; 腰椎间盘突出; 经皮内镜下腰椎间盘切除术; 椎间孔入路; 椎板间入路; Meta 分析; 系统评价; 随机对照试验; 队列研究

Key words: Lumbar vertebrae; Intervertebral disc herniation; Percutaneous endoscopic lumbar discectomy; Transforaminal approach; Interlaminar approach; Meta-analysis; Systematic review; Randomized controlled trial; Cohort study

引用本文: 张腾飞, 吴文凯, 邓忠良, 晏铮剑, 陈亮. PELD 椎间孔入路与椎板间入路治疗 L5/S1 椎间盘突出症疗效和安全性的 Meta 分析. 中国循证医学杂志, 2018, 18(4): 340-346. doi: 10.7507/1672-2531.201710105 复制

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