经皮椎间孔镜与椎板开窗髓核摘除术治疗腰椎间盘突出症的Meta分析
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摘要
目的比较经皮椎间孔镜髓核摘除术(percutaneous endoscopic lumbar discectomy,PELD)与椎板开窗髓核摘除术(fenestration discectomy,FD)治疗腰椎间盘突出症(lumbar disc herniation,LDH)的治疗效果,为椎间孔镜技术在临床的进一步应用提供循证医学证据。方法在Pubmed、Embase、SpringerLink、重庆维普、同方等数据库中检索"椎间孔镜、BEIS、PELD、PTED、TESSYS"。纳入对比分析椎间孔镜与开窗髓核摘除术治疗腰椎间盘突出症的治疗效果的文献,应用New castle-Ottawa量表评价文献质量,并提取相关数据,运用ReviewManager 5.3软件进行Meta分析。结果共28项研究符合纳入标准,总样本量为2 355例,其中PELD组1 211例,FD组1 144例。Meta分析结果显示,PELD组患者手术时间、术中出血量、切口长度、住院时间较FD组均较少,术后疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)、JOA评分(Japanese Orthopaedic Association Scores)均优于FD组。结论经皮椎间孔镜技术相比椎板开窗髓核摘除术能明显减少出血及并发症,临床应用可期。
Objective Comparison of percutaneous endoscopic lumbar discectomy(PELD) and fenestration discectomy(FD) in the treatment of lumbar disc herniation(LDH) treatment effect for transforaminal endoscopic technique in clinical application to provide evidence-based medicine evidence.Methods Retrieve "BEIS or PELD or PTED or TESSYS" in Pubmed,Embase,SpringerLink,VIP,Chongqing VIP and Tongfang data etc.The literature of the treatment of lumbar intervertebral disc herniation by means of comparative analysis of intervertebral foraminoscopy and extirpation of nucleus window nucleus pulposus.New Castle-Ottawa scale was used to evaluate the quality of documents and to extract data.Review Manager 5.3 software was used for Meta analysis.Results A total of 28 studies were in conformity with the inclusion criteria,with a total sample size of 2 355 cases,of which 1 211 were in group PELD and 1 144 in group FD.The results of Meta analysis showed that the operation time,intraoperative blood loss,length of incision,and length of hospital stay in the PELD group were less than FD group,postoperative pain visual analogue scale(VAS),Oswestry disability index(ODI),Japanese Orthopaedic Association scores(JOA) is better than FD group.Conclusion Compared with traditional fenestration,percutaneous transforaminal endoscopy is a new minimally invasive surgical technique.It can significantly reduce bleeding and complications under the premise of good curative effect,and it can be further developed in clinical work.
Objective Comparison of percutaneous endoscopic lumbar discectomy(PELD) and fenestration discectomy(FD) in the treatment of lumbar disc herniation(LDH) treatment effect for transforaminal endoscopic technique in clinical application to provide evidence-based medicine evidence.Methods Retrieve "BEIS or PELD or PTED or TESSYS" in Pubmed,Embase,SpringerLink,VIP,Chongqing VIP and Tongfang data etc.The literature of the treatment of lumbar intervertebral disc herniation by means of comparative analysis of intervertebral foraminoscopy and extirpation of nucleus window nucleus pulposus.New Castle-Ottawa scale was used to evaluate the quality of documents and to extract data.Review Manager 5.3 software was used for Meta analysis.Results A total of 28 studies were in conformity with the inclusion criteria,with a total sample size of 2 355 cases,of which 1 211 were in group PELD and 1 144 in group FD.The results of Meta analysis showed that the operation time,intraoperative blood loss,length of incision,and length of hospital stay in the PELD group were less than FD group,postoperative pain visual analogue scale(VAS),Oswestry disability index(ODI),Japanese Orthopaedic Association scores(JOA) is better than FD group.Conclusion Compared with traditional fenestration,percutaneous transforaminal endoscopy is a new minimally invasive surgical technique.It can significantly reduce bleeding and complications under the premise of good curative effect,and it can be further developed in clinical work.
引文
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[12] Choi K, Kim J, Park C. Percutaneous Endoscopic Lumbar Discec-tomy as an Alternative to Open Lumbar Microdiscectomy for Lar-ge Lumbar Disc Herniation[J]. Pain Physician, 2016, 19(2):291-300.
[13]涂庆生,程建斌,王金秀.侧路椎间孔镜髓核摘除术与传统手术方法治疗腰椎间盘突出症的效果比较[J].中国医药指南, 2016,14(25):26-27.
[14]石裕明,王荣生,何立文.对比分析椎间孔镜术与传统椎板间开窗术治疗中青年腰椎间盘突出症的临床疗效[J].临床医学,2016, 36(9):33-35.
[15]高全有,韩康,高浩然,等.经皮椎板间内镜与椎板小开窗术治疗腰椎间盘突出症临床疗效比较[J].现代生物医学进展, 2015,15(34):6736-6739.
[16]丁伟国,徐卫星,卢笛,等.经皮椎间孔镜与开放椎板间开窗术治疗腰椎间盘突出症的疗效分析[J].中国内镜杂志, 2016, 22(4):43-48.
[17]袁超,孙海燕,丁超,等.经皮椎间孔镜腰椎间盘切除术与开窗腰椎间盘切除术治疗腰椎间盘突出症的疗效对比[J].颈腰痛杂志, 2016, 37(6):482-486.
[18]韩康,高浩然,卞娜,等.经皮椎间孔镜与单纯椎板开窗术治疗腰椎间盘突出症临床疗效比较[J].中华全科医学, 2015,13(06):868-871.
[19]崔维,林欣,王磊,等.经皮椎间孔镜与开放性手术治疗腰椎间盘突出症的疗效对比[J].中国临床医生, 2014,42(4):60-62.
[20]李兴艳,张津铭,叶亚平,等.经皮椎间孔镜与椎板开窗术治疗腰椎间盘突出症的疗效对比[J].中国骨与关节损伤杂志, 2015,30(5):467-469.
[21]张鑫.经皮椎间孔镜与椎板开窗髓核摘除手术治疗肥胖患者腰椎盘突出症的临床疗效比较[D].石家庄:河北医科大学, 2016:1-46.
[22]赵锡武,韩康,刘鑫,等.经皮椎间孔镜与椎板开窗髓核摘除术治疗腰椎间盘突出症的临床疗效比较[J].现代生物医学进展,2015, 15(14):2692-2695, 2706.
[23]方卫军,李章华,潘峰,等.经皮椎间孔镜与椎板开窗治疗腰椎间盘突出症的疗效分析[J].现代生物医学进展, 2016,16(34):6660-6664.
[24]王建顺,张军,王新虎,等.经皮椎间孔镜与小开窗髓核摘除术治疗腰椎间盘突出症的疗效比较[J].颈腰痛杂志, 2016,37(4):300-302.
[25]梁涛.探讨椎间孔镜与小切口手术治疗腰椎间盘突出症的临床效果[J].中国继续医学教育, 2016, 8(18):105-106.
[26]陶志强,吴庭胜,范少勇,等.椎间孔镜与开放术治疗腰椎间盘突出症的疗效分析[J].江西医药, 2016,51(1):32-34, 49.
[27]赵显,宋涛,孙新宏.椎间孔镜技术与椎板间开窗治疗双节段腰椎间盘突出症的疗效观察[J].临床骨科杂志,2015, 18(6):662-666.
[28]任佳彬,刘鹏飞,孙兆忠,等.椎间孔镜术与传统椎板间开窗术治疗青少年腰椎间盘突出症的比较研究[J].中国矫形外科杂志,2015,23(21):1938-1942.
[29]刘晓宁,仝超,孔德明,等.椎间孔镜与传统开放手术治疗糖尿病患者腰椎间盘突出症的疗效分析[J].外科研究与新技术,2015,4(3):169-171.
[30]顾丽丽,张学学,张华秀,等.椎间孔镜与单纯髓核摘除术治疗单节段腰椎间盘突出症的疗效比较[J].中国现代医学杂志,2016,26(23):115-118.
[31]潘琦.椎间孔镜与开窗治疗椎间盘突出症术后的疗效比较[J].中国医药指南, 2017,15(1):108-109.
[32]邵凌云,孙志峰,何斌.椎间孔镜与开放手术治疗腰椎间盘突出症的对比研究[J].齐齐哈尔医学院学报, 2015, 36(34):5167-5168.
[33]巩陈,呼国臣,申才良.椎间孔镜神经根减压松解术与椎板间开窗髓核摘除术治疗单节段单侧腰椎间盘突出症对比观察[J].山东医药, 2016, 56(27):87-89.
[34]刘俊良,镇万新,高国勇,等.椎间孔镜与椎板开窗治疗腰椎间盘突出症的前瞻性对照研究[J].中国骨与关节杂志, 2014(4):245-250.
[35]邹逢文,张宪彧,吴小华,等.椎间孔镜与小切口手术治疗腰椎间盘突出症的临床效果比较[J].中国当代医药, 2016, 23(1):116-118.
[36] Smith L Chemonucleolysis. Personal history, trials, and tribulation[J]. Clin Orthop Reslat Res, 1993,(287):117-124.
[37] Ruetten S, Komp M, Merk H, et al. Full-endoscopic interlaminarand transforaminal lumbar disceetomy versus conventional micro-surgical technique:prospective, randomized, controlled study[J].Spine, 2008, 33(9):931-939.
[38]谢旭华,雷云坤,刘伟,等.经皮椎间孔镜治疗腰椎间盘突出症临床疗效观察.中国矫形外科杂志, 2012(5):463-465.
[39] Yeung AT, Tsou PM. Posterolateral endoscopic excision for lum-bar disc herniation:Surgical technique, outcome, and complica-tions in 307 consecutive cases[J]. Spine, 2002, 27(7):722-731.
[2] Kogias E, Franco Jimenez P, Klingler JH, et al. Minimally invasiveredo discectomy for recurrent lumbar[J]. J Clin Neurosci, 2015, 22(9):1382-1386.
[3] Hijikata S, Yangshi M, Nakayama T, et al. Percutaneous discec-tomy:a new treatment method for lumbar disc herniation[J]. J To-den Hosp, 1975, 5(2):5-13.
[4] Schreiber A, Suezawa Y, Leu H. Does pecutaneous nucleotomywith discoscopy replace conventional disceetomy? Eight years ofexperience and results in treatment of herniated lumbar disc[J].Clin Orthop Relat Res, 1989, 238(1):35.
[5] Yeung AT. Minimally invasive disc surgery with the Yeung endos-copic spine system(YESS)[J]. Surg Technol Int, 1999, 8:267-277.
[6] Hoogland T, Schube M, Miklitz B, et al. Transforaminal postemlateralen doscopic discectomy with or without the combination ofalowdose chymopapain:a prospective randomized study in 280consecutive cases[J]. Spine, 2006, 31(24):E890-E897.
[7] Stang A. CriticaI evaIuation of the Newcastle-0ttawascale for theassessment of the quality of nonrandomized studies in meta-analy-ses[J]. Eur J Epidemiol, 2010, 25(9):603-605.
[8] Chen H, Lee C, Wei L, et al. Comparison of Percutaneous Endos-copic Lumbar Discectomy and Open Lumbar Surgery for Adjac-ent Segment Degeneration and Recurrent Disc Herniation[J].Neurology Research International, 2015, 2015:791943.
[9] Pan L, Zhang P, Yin Q. Comparison of tissue damages caused byendoscopic lumbar discectomy and traditional lumbar discectomy:A randomised controlled trial[J]. International Journal of Surgery,2014, 12(5):534-537.
[10] Pan Z, Ha Y, Yi S, et al. Efficacy of Transforaminal EndoscopicSpine System(TESSYS)Technique in Treating Lumbar Disc Her-niation[J]. Medical Science Monitor, 2016, 22:530-539.
[11] Ahn S, Kim S, Kim D, et al. Comparison of Outcomes of Percu-taneous Endoscopic Lumbar Discectomy and Open LumbarMicrodiscectomy for Young Adults:A Retrospective MatchedCohort Study[J]. World Neurosurgery, 2016, 86:250-258.
[12] Choi K, Kim J, Park C. Percutaneous Endoscopic Lumbar Discec-tomy as an Alternative to Open Lumbar Microdiscectomy for Lar-ge Lumbar Disc Herniation[J]. Pain Physician, 2016, 19(2):291-300.
[13]涂庆生,程建斌,王金秀.侧路椎间孔镜髓核摘除术与传统手术方法治疗腰椎间盘突出症的效果比较[J].中国医药指南, 2016,14(25):26-27.
[14]石裕明,王荣生,何立文.对比分析椎间孔镜术与传统椎板间开窗术治疗中青年腰椎间盘突出症的临床疗效[J].临床医学,2016, 36(9):33-35.
[15]高全有,韩康,高浩然,等.经皮椎板间内镜与椎板小开窗术治疗腰椎间盘突出症临床疗效比较[J].现代生物医学进展, 2015,15(34):6736-6739.
[16]丁伟国,徐卫星,卢笛,等.经皮椎间孔镜与开放椎板间开窗术治疗腰椎间盘突出症的疗效分析[J].中国内镜杂志, 2016, 22(4):43-48.
[17]袁超,孙海燕,丁超,等.经皮椎间孔镜腰椎间盘切除术与开窗腰椎间盘切除术治疗腰椎间盘突出症的疗效对比[J].颈腰痛杂志, 2016, 37(6):482-486.
[18]韩康,高浩然,卞娜,等.经皮椎间孔镜与单纯椎板开窗术治疗腰椎间盘突出症临床疗效比较[J].中华全科医学, 2015,13(06):868-871.
[19]崔维,林欣,王磊,等.经皮椎间孔镜与开放性手术治疗腰椎间盘突出症的疗效对比[J].中国临床医生, 2014,42(4):60-62.
[20]李兴艳,张津铭,叶亚平,等.经皮椎间孔镜与椎板开窗术治疗腰椎间盘突出症的疗效对比[J].中国骨与关节损伤杂志, 2015,30(5):467-469.
[21]张鑫.经皮椎间孔镜与椎板开窗髓核摘除手术治疗肥胖患者腰椎盘突出症的临床疗效比较[D].石家庄:河北医科大学, 2016:1-46.
[22]赵锡武,韩康,刘鑫,等.经皮椎间孔镜与椎板开窗髓核摘除术治疗腰椎间盘突出症的临床疗效比较[J].现代生物医学进展,2015, 15(14):2692-2695, 2706.
[23]方卫军,李章华,潘峰,等.经皮椎间孔镜与椎板开窗治疗腰椎间盘突出症的疗效分析[J].现代生物医学进展, 2016,16(34):6660-6664.
[24]王建顺,张军,王新虎,等.经皮椎间孔镜与小开窗髓核摘除术治疗腰椎间盘突出症的疗效比较[J].颈腰痛杂志, 2016,37(4):300-302.
[25]梁涛.探讨椎间孔镜与小切口手术治疗腰椎间盘突出症的临床效果[J].中国继续医学教育, 2016, 8(18):105-106.
[26]陶志强,吴庭胜,范少勇,等.椎间孔镜与开放术治疗腰椎间盘突出症的疗效分析[J].江西医药, 2016,51(1):32-34, 49.
[27]赵显,宋涛,孙新宏.椎间孔镜技术与椎板间开窗治疗双节段腰椎间盘突出症的疗效观察[J].临床骨科杂志,2015, 18(6):662-666.
[28]任佳彬,刘鹏飞,孙兆忠,等.椎间孔镜术与传统椎板间开窗术治疗青少年腰椎间盘突出症的比较研究[J].中国矫形外科杂志,2015,23(21):1938-1942.
[29]刘晓宁,仝超,孔德明,等.椎间孔镜与传统开放手术治疗糖尿病患者腰椎间盘突出症的疗效分析[J].外科研究与新技术,2015,4(3):169-171.
[30]顾丽丽,张学学,张华秀,等.椎间孔镜与单纯髓核摘除术治疗单节段腰椎间盘突出症的疗效比较[J].中国现代医学杂志,2016,26(23):115-118.
[31]潘琦.椎间孔镜与开窗治疗椎间盘突出症术后的疗效比较[J].中国医药指南, 2017,15(1):108-109.
[32]邵凌云,孙志峰,何斌.椎间孔镜与开放手术治疗腰椎间盘突出症的对比研究[J].齐齐哈尔医学院学报, 2015, 36(34):5167-5168.
[33]巩陈,呼国臣,申才良.椎间孔镜神经根减压松解术与椎板间开窗髓核摘除术治疗单节段单侧腰椎间盘突出症对比观察[J].山东医药, 2016, 56(27):87-89.
[34]刘俊良,镇万新,高国勇,等.椎间孔镜与椎板开窗治疗腰椎间盘突出症的前瞻性对照研究[J].中国骨与关节杂志, 2014(4):245-250.
[35]邹逢文,张宪彧,吴小华,等.椎间孔镜与小切口手术治疗腰椎间盘突出症的临床效果比较[J].中国当代医药, 2016, 23(1):116-118.
[36] Smith L Chemonucleolysis. Personal history, trials, and tribulation[J]. Clin Orthop Reslat Res, 1993,(287):117-124.
[37] Ruetten S, Komp M, Merk H, et al. Full-endoscopic interlaminarand transforaminal lumbar disceetomy versus conventional micro-surgical technique:prospective, randomized, controlled study[J].Spine, 2008, 33(9):931-939.
[38]谢旭华,雷云坤,刘伟,等.经皮椎间孔镜治疗腰椎间盘突出症临床疗效观察.中国矫形外科杂志, 2012(5):463-465.
[39] Yeung AT, Tsou PM. Posterolateral endoscopic excision for lum-bar disc herniation:Surgical technique, outcome, and complica-tions in 307 consecutive cases[J]. Spine, 2002, 27(7):722-731.