微创通道系统治疗腰椎管狭窄症的文献回顾
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摘要
目的综合分析微创通道系统治疗腰椎管狭窄症已发表文章,探讨微创通道系统治疗腰椎管狭窄症的疗效及安全性。方法系统检索2004年1月~2015年3月微创通道系统治疗腰椎管狭窄症的相关文献,按照纳入标准和剔除标准进行筛选,提取需要数据,采用循证医学分析方法,加权汇总纳入文献样本的一般资料、临床疗效并进行系统分析。结果共检出489篇相关文献,按照筛选标准筛选后,共有9篇被纳入分析,共有361例患者,其中男174例、女187例,平均年龄为56岁。平均手术时间89分钟,平均出血量149mL,术前VAS评分平均为6.7,末次随访VAS评分平均为1.5,差异有统计学意义(t=7.21,P<0.001)。结论微创通道系统治疗腰椎管狭窄症,手术时间短,出血量少,临床疗效良好。
Objective To systematically review the safety and efficacy of minimally invasive channel system for lumbar spine stenosis. Methods The literature about minimally invasive channel system for lumbar spine stenosis were searched from Jan 2004 to Mar 2015. According to established inclusion and exclusion criteria, literature met evaluation criteria were selected, and data were analyzed with weighted meta-analysis of evidence-based medicine analysis. General information, clinical approach and complications were especially concerned. Results Nine trials involving 361 patients were included in this study. There are 174 males and 187 females. The results showed: weight average age was 56 years old, and weight average operation time was 89 min, weight average amount of bleeding was 149 mL, postoperative weighted preoperative VAS score was 6.7, weighted the last follow-up VAS score was 1.5,( t=7.21,P <0.001). Conclusion The minimally invasive channel system for lumbar spinal stenosis had a great clinical curative effect for shorter operation time and blood loss.
Objective To systematically review the safety and efficacy of minimally invasive channel system for lumbar spine stenosis. Methods The literature about minimally invasive channel system for lumbar spine stenosis were searched from Jan 2004 to Mar 2015. According to established inclusion and exclusion criteria, literature met evaluation criteria were selected, and data were analyzed with weighted meta-analysis of evidence-based medicine analysis. General information, clinical approach and complications were especially concerned. Results Nine trials involving 361 patients were included in this study. There are 174 males and 187 females. The results showed: weight average age was 56 years old, and weight average operation time was 89 min, weight average amount of bleeding was 149 mL, postoperative weighted preoperative VAS score was 6.7, weighted the last follow-up VAS score was 1.5,( t=7.21,P <0.001). Conclusion The minimally invasive channel system for lumbar spinal stenosis had a great clinical curative effect for shorter operation time and blood loss.
引文
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[2]Kreiner DS,Shaffer WO,Baisden JL,et al.An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis(update)[J].Spine J,2013,13(7):734-743.
[3]杨补,陈瑞强,谢沛根,等.单侧入路显微内镜椎管减压术治疗腰椎管狭窄症[J].中国修复重建外科杂志,2011,25(10):1158-1163.
[4]文天林,刘秀梅,杜培,等.Quadrant微创通道下单侧开窗减压与开放减压内固定术治疗退变性腰椎管狭窄症病例对照研究[J].中国骨伤,2014(08):658-662.
[5]杨佳宁,宋有鑫,赵丽丽,等.后路Quadrant通道下MIS-TLIF微创手术治疗老年退变性腰椎管狭窄症的临床疗效[J].中国矫形外科杂志,2016(05):395-400.
[6]张文志,段丽群,尚希福,等.显微镜辅助下微创经椎间孔腰椎椎间融合术治疗腰椎退行性疾病的疗效观察[J].中国修复重建外科杂志,2013(03):268-273.
[7]李浩曦,孙宏志,胡朝晖,等.微椎管减压术与传统椎管减压术治疗腰椎管狭窄症的比较性研究[J].中国现代手术学杂志,2013,17(1):36-40.
[8]Slatis P,Malmivaara A,Heliovaara M,et al.Long-term results of surgery for lumbar spinal stenosis:a randomised controlled trial[J].Eur Spine J,2011,20(7):1174-1181.
[9]陈宣煌,郑祖高,张怀志,等.椎间盘镜下椎管扩大减压术治疗退变性腰椎管狭窄症的临床研究[J].医学综述,2012,18(5):779-782.
[10]Liu X,Yuan S,Tian Y.Modified unilateral laminotomy for bilateral decompression for lumbar spinal stenosis:technical note[J].Spine(Phila Pa 1976),2013,38(12):732-737.
[11]Celik S E,Celik S,Goksu K,et al.Microdecompressive laminatomy with a 5-year follow-up period for severe lumbar spinal stenosis[J].J Spinal Disord Tech,2010,23(4):229-235.
[12]范绪涛,孟纯阳.后路显微椎间盘镜的发展及临床应用现状[J].中国矫形外科杂志,2015(09):808-811.
[13]Foley KT,Smith M M.Image-guided spine surgery[J].Neurosurg Clin N Am,1996,2:171-186.
[14]Foley KT,Lefkowitz MA.Advances in minimally invasive spine surgery[J].Clin Neurosurg,2002,3:499-517.
[15]Cavusoglu H,Turkmenoglu O,Kaya R A,et al.Efficacy of unilateral laminectomy for bilateral decompression in lumbar spinalstenosis[J].Turk Neurosurg,2007,17(2):100-108.
[16]Mobbs R J,Li J,Sivabalan P,et al.Outcomes after decompressive laminectomy for lumbar spinal stenosis:comparison between minimally invasive unilateral laminectomy for bilateral decompression and open laminectomy:clinical article[J].J Neurosurg Spine,2014,21(2):179-186.
[17]Usman M,Ali M,Khanzada K,et al.Unilateral approach for bilateral decompression of lumbar spinal stenosis:a minimal invasive surgery[J].J Coll Physicians Surg Pak,2013,23(12):852-856.
[18]Yagi M,Okada E,Ninomiya K,et al.Postoperative outcome after modified unilateral-approach microendoscopic midline decompression for degenerative spinal stenosis[J].J Neurosurg Spine,2009,10(4):293-299.
[19]Komp M,Hahn P,Merk H,et al.Bilateral operation of lumbar degenerative central spinal stenosis in full-endoscopic interlaminar technique with unilateral approach:prospective 2-year results of74 patients[J].J Spinal Disord Tech,2011,24(5):281-287.
[20]Komp M,Hahn P,Oezdemir S,et al.Bilateral spinal decompression of lumbar central stenosis with the full-endoscopic interlaminar versus microsurgical laminotomy technique:a prospective,randomized,controlled study[J].Pain Physician,2015,18(1):61-70.
[21]Ruetten S,Komp M,Merk H,et al.Surgical treatment for lumbar lateral recess stenosis with the full-endoscopic interlaminar approach versus conventional microsurgical technique:a prospective,randomized,controlled study[J].J Neurosurg Spine,2009,10(5):476-485.
[22]Phan K,Mobbs R J.Minimally Invasive Versus Open Laminectomy for Lumbar Stenosis:A Systematic Review and Meta-Analysis[J].Spine(Phila Pa 1976),2016,41(2):91-100.
[23]Ikuta K,Arima J,Tanaka T,et al.Short-term results of microendoscopic posterior decompression for lumbar spinal stenosis.Technical note[J].J Neurosurg Spine,2005,2(5):624-633.
[24]Asazuma T,Stokes I A,Moreland M S,et al.Intersegmental spinal flexibility with lumbosacral instrumentation.An in vitro biomechanical investigation[J].Spine(Phila Pa 1976),1990,15(11):1153-1158.
[25]陈远明,靳安民,张辉,等.“开窗技术”治疗退行性腰椎管狭窄症融合指征[J].中华外科杂志,2010,48(1):31-34.
[26]F rsth P,ólafsson G,Carlsson T,et al.A Randomized,Controlled Trial of Fusion Surgery for Lumbar Spinal Stenosis[J].N Engl J Med,2016,374(15):1413-1423.
[27]Ghogawala Z,Dziura J,Butler WE,et al.Laminectomy plus Fusion versus Laminectomy Alone for Lumbar Spondylolisthesis[J].N Engl J Med,2016,374(15):1424-34.
[28]陆晓生,赵劲民,彭昊,等.改良脊柱显微内窥镜系统手术治疗腰椎管狭窄症的前瞻性研究[J].中国骨与关节损伤杂志,2013(05):412-414.
[29]田小武,张贤,黄承军,等.腰椎神经根管狭窄的区域划分与MED手术[J].中国骨与关节损伤杂志,2004,19(4):224-226.
[2]Kreiner DS,Shaffer WO,Baisden JL,et al.An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis(update)[J].Spine J,2013,13(7):734-743.
[3]杨补,陈瑞强,谢沛根,等.单侧入路显微内镜椎管减压术治疗腰椎管狭窄症[J].中国修复重建外科杂志,2011,25(10):1158-1163.
[4]文天林,刘秀梅,杜培,等.Quadrant微创通道下单侧开窗减压与开放减压内固定术治疗退变性腰椎管狭窄症病例对照研究[J].中国骨伤,2014(08):658-662.
[5]杨佳宁,宋有鑫,赵丽丽,等.后路Quadrant通道下MIS-TLIF微创手术治疗老年退变性腰椎管狭窄症的临床疗效[J].中国矫形外科杂志,2016(05):395-400.
[6]张文志,段丽群,尚希福,等.显微镜辅助下微创经椎间孔腰椎椎间融合术治疗腰椎退行性疾病的疗效观察[J].中国修复重建外科杂志,2013(03):268-273.
[7]李浩曦,孙宏志,胡朝晖,等.微椎管减压术与传统椎管减压术治疗腰椎管狭窄症的比较性研究[J].中国现代手术学杂志,2013,17(1):36-40.
[8]Slatis P,Malmivaara A,Heliovaara M,et al.Long-term results of surgery for lumbar spinal stenosis:a randomised controlled trial[J].Eur Spine J,2011,20(7):1174-1181.
[9]陈宣煌,郑祖高,张怀志,等.椎间盘镜下椎管扩大减压术治疗退变性腰椎管狭窄症的临床研究[J].医学综述,2012,18(5):779-782.
[10]Liu X,Yuan S,Tian Y.Modified unilateral laminotomy for bilateral decompression for lumbar spinal stenosis:technical note[J].Spine(Phila Pa 1976),2013,38(12):732-737.
[11]Celik S E,Celik S,Goksu K,et al.Microdecompressive laminatomy with a 5-year follow-up period for severe lumbar spinal stenosis[J].J Spinal Disord Tech,2010,23(4):229-235.
[12]范绪涛,孟纯阳.后路显微椎间盘镜的发展及临床应用现状[J].中国矫形外科杂志,2015(09):808-811.
[13]Foley KT,Smith M M.Image-guided spine surgery[J].Neurosurg Clin N Am,1996,2:171-186.
[14]Foley KT,Lefkowitz MA.Advances in minimally invasive spine surgery[J].Clin Neurosurg,2002,3:499-517.
[15]Cavusoglu H,Turkmenoglu O,Kaya R A,et al.Efficacy of unilateral laminectomy for bilateral decompression in lumbar spinalstenosis[J].Turk Neurosurg,2007,17(2):100-108.
[16]Mobbs R J,Li J,Sivabalan P,et al.Outcomes after decompressive laminectomy for lumbar spinal stenosis:comparison between minimally invasive unilateral laminectomy for bilateral decompression and open laminectomy:clinical article[J].J Neurosurg Spine,2014,21(2):179-186.
[17]Usman M,Ali M,Khanzada K,et al.Unilateral approach for bilateral decompression of lumbar spinal stenosis:a minimal invasive surgery[J].J Coll Physicians Surg Pak,2013,23(12):852-856.
[18]Yagi M,Okada E,Ninomiya K,et al.Postoperative outcome after modified unilateral-approach microendoscopic midline decompression for degenerative spinal stenosis[J].J Neurosurg Spine,2009,10(4):293-299.
[19]Komp M,Hahn P,Merk H,et al.Bilateral operation of lumbar degenerative central spinal stenosis in full-endoscopic interlaminar technique with unilateral approach:prospective 2-year results of74 patients[J].J Spinal Disord Tech,2011,24(5):281-287.
[20]Komp M,Hahn P,Oezdemir S,et al.Bilateral spinal decompression of lumbar central stenosis with the full-endoscopic interlaminar versus microsurgical laminotomy technique:a prospective,randomized,controlled study[J].Pain Physician,2015,18(1):61-70.
[21]Ruetten S,Komp M,Merk H,et al.Surgical treatment for lumbar lateral recess stenosis with the full-endoscopic interlaminar approach versus conventional microsurgical technique:a prospective,randomized,controlled study[J].J Neurosurg Spine,2009,10(5):476-485.
[22]Phan K,Mobbs R J.Minimally Invasive Versus Open Laminectomy for Lumbar Stenosis:A Systematic Review and Meta-Analysis[J].Spine(Phila Pa 1976),2016,41(2):91-100.
[23]Ikuta K,Arima J,Tanaka T,et al.Short-term results of microendoscopic posterior decompression for lumbar spinal stenosis.Technical note[J].J Neurosurg Spine,2005,2(5):624-633.
[24]Asazuma T,Stokes I A,Moreland M S,et al.Intersegmental spinal flexibility with lumbosacral instrumentation.An in vitro biomechanical investigation[J].Spine(Phila Pa 1976),1990,15(11):1153-1158.
[25]陈远明,靳安民,张辉,等.“开窗技术”治疗退行性腰椎管狭窄症融合指征[J].中华外科杂志,2010,48(1):31-34.
[26]F rsth P,ólafsson G,Carlsson T,et al.A Randomized,Controlled Trial of Fusion Surgery for Lumbar Spinal Stenosis[J].N Engl J Med,2016,374(15):1413-1423.
[27]Ghogawala Z,Dziura J,Butler WE,et al.Laminectomy plus Fusion versus Laminectomy Alone for Lumbar Spondylolisthesis[J].N Engl J Med,2016,374(15):1424-34.
[28]陆晓生,赵劲民,彭昊,等.改良脊柱显微内窥镜系统手术治疗腰椎管狭窄症的前瞻性研究[J].中国骨与关节损伤杂志,2013(05):412-414.
[29]田小武,张贤,黄承军,等.腰椎神经根管狭窄的区域划分与MED手术[J].中国骨与关节损伤杂志,2004,19(4):224-226.