经皮脊柱内镜技术与传统开放手术治疗腰椎间盘突出症并发症的系统评价与Meta分析
|
摘要
目的 :系统分析经皮脊柱内镜技术与传统开放手术治疗腰椎间盘突出症的相关的并发症发生率及其特点。方法:两位作者独立对MEDLINE、Cochrane library、Pubmed数据库、Web of Science、中国期刊全文数据库(CNKI)、万方数据库和Embase数据库进行关于经皮脊柱内镜技术和传统开放手术治疗腰椎间盘突出症相关的并发症的随机对照试验(RCT)及队列研究进行搜索。语种不限。两位作者独立评估各研究的质量,且将各研究中的术中和术后各种并发症(术后感觉异常、神经根直接损伤、硬脊膜损伤、术区伤口并发症、椎间盘复发、髓核部分残留、相关并发症的额外手术及其他并发症)等提取整理为电子基线表,并将这些研究的数据通过Revman 5.3软件进行Meta分析与综合,以评估两种手术技术在各种并发症方面的统计学意义。结果:共有24篇研究最终被纳入,共计2797例患者被纳入分析。经皮脊柱内镜技术与传统开放手术比较:两者的术后感觉异常[OR=0.84,95%CI(0.57,1.24)]的发生率相等。前者相关并发症的额外手术[OR=1.15,95%CI(0.79,1.66)]的发生率略高,但无统计学差异(P>0.05);后者椎间盘复发[OR=1.03,95%CI(0.67,1.61)]、其他并发症[OR=0.88,95%CI(0.53,1.46)]的发生率高于前者,但亦无统计学差异(P>0.05);前者髓核部分残留[OR=2.82,95%CI(1.36,5.85)]的发生率较高,差异有统计学意义(P<0.05);后者神经根直接损伤[OR=0.28,95%CI(0.09,0.80)]、硬脊膜损伤[OR=0.34,95%CI(0.17,0.70)]、术区伤口并发症[OR=0.31,95%CI(0.14,0.70)]的发生率较高,差异有统计学意义(P<0.05)。结论:相对于传统开放手术治疗腰椎间盘突出症,经皮脊柱内镜技术在减少神经根损伤、硬脊膜损伤及术区伤口并发症方面占有明显优势,但在防止手术部位髓核残留方面受限于经皮内镜技术特点,差于开放手术。
Objectives: To systematically analyze the incidence and characteristics of complications for percutaneous spinal endoscopy and conventional open surgery in lumbar disc herniation. Methods: Randomized controlled trails and cohort studies were searched independently by two authors in MEDLINE, Cochrane library, Pubmed database, Web of Science, China Knowledge Network, Wanfang and Embase databases on percutaneous spinal endoscopy and traditional open surgery for lumbar disc herniation. There was no limit to the language. The authors independently assessed the quality of each study, extracted the intraoperative and postoperative complications(postoperative paresthesia, direct nerve root injury, dural injury, surgical site wound complications, intervertebral disc recurrence, residual nucleus pulposus, additional surgery for associated complications and other complications) in each study into an electronic baseline table and analyzed the data through Revman 5.3 software for meta-analysis and synthesis. Various complications were evaluated between the two surgical techniques. Results: A total of 24 studies were eventually included, and a total of 2797 patients was included in the analysis. Comparing percutaneous spinal endoscopy and conventional open surgery,the incidence of postoperative sensory abnormalities[OR=0.84, 95% CI(0.57, 1.24)] was essentially the same.The incidence of additional surgery related to complication[OR=1.15, 95% CI(0.79, 1.66)] was slightly higher,but there was no significant difference(P>0.05). The incidence of intervertebral disc recurrence[OR=1.03, 95%CI(0.67, 1.61)] and other complications[OR=0.88, 95% CI(0.53, 1.46)] in the latter was slightly higher than the former, but there was no significant difference(P>0.05). The incidence of nucleus pulposus residue in the former[OR=2.82, 95% CI(1.36, 5.85)] was higher, the difference was significant(P <0.05). The incidences of nerve root injury[OR=0.28, 95% CI(0.09, 0.80)], dural injury[OR=0.34, 95% CI(0.17, 0.70)], wound complication in operation area[OR=0.31, 95% CI(0.14, 0.70)] in the latter were higher, the differences were significant(P<0.05). Conclusions: Compared with traditional open surgery for lumbar disc herniation, percutaneous spinal endoscopy has a significant advantage in reducing nerve root injury, dura mater injury and wound complications in the operation area, but is limited in preventing residual nucleus pulposus at the surgical site. The characteristics of percutaneous endoscopy are worse than open surgery.
Objectives: To systematically analyze the incidence and characteristics of complications for percutaneous spinal endoscopy and conventional open surgery in lumbar disc herniation. Methods: Randomized controlled trails and cohort studies were searched independently by two authors in MEDLINE, Cochrane library, Pubmed database, Web of Science, China Knowledge Network, Wanfang and Embase databases on percutaneous spinal endoscopy and traditional open surgery for lumbar disc herniation. There was no limit to the language. The authors independently assessed the quality of each study, extracted the intraoperative and postoperative complications(postoperative paresthesia, direct nerve root injury, dural injury, surgical site wound complications, intervertebral disc recurrence, residual nucleus pulposus, additional surgery for associated complications and other complications) in each study into an electronic baseline table and analyzed the data through Revman 5.3 software for meta-analysis and synthesis. Various complications were evaluated between the two surgical techniques. Results: A total of 24 studies were eventually included, and a total of 2797 patients was included in the analysis. Comparing percutaneous spinal endoscopy and conventional open surgery,the incidence of postoperative sensory abnormalities[OR=0.84, 95% CI(0.57, 1.24)] was essentially the same.The incidence of additional surgery related to complication[OR=1.15, 95% CI(0.79, 1.66)] was slightly higher,but there was no significant difference(P>0.05). The incidence of intervertebral disc recurrence[OR=1.03, 95%CI(0.67, 1.61)] and other complications[OR=0.88, 95% CI(0.53, 1.46)] in the latter was slightly higher than the former, but there was no significant difference(P>0.05). The incidence of nucleus pulposus residue in the former[OR=2.82, 95% CI(1.36, 5.85)] was higher, the difference was significant(P <0.05). The incidences of nerve root injury[OR=0.28, 95% CI(0.09, 0.80)], dural injury[OR=0.34, 95% CI(0.17, 0.70)], wound complication in operation area[OR=0.31, 95% CI(0.14, 0.70)] in the latter were higher, the differences were significant(P<0.05). Conclusions: Compared with traditional open surgery for lumbar disc herniation, percutaneous spinal endoscopy has a significant advantage in reducing nerve root injury, dura mater injury and wound complications in the operation area, but is limited in preventing residual nucleus pulposus at the surgical site. The characteristics of percutaneous endoscopy are worse than open surgery.
引文
1. Mixter WJ, Barr JS. Rupture of the intervertebral disc with involvement of the spinal canal[J]. New Eng J Med, 1934,211(6):210-215.
2 . Kim DY, Lee SH, Chung SK, et al. Comparison of multifidus muscle atrophy and trunk extension muscle strength percutaneous versus open pedicle screw fixation[J]. Spine, 2005, 30(1):123-129.
3 . Huang TJ, Hsu RW, Li YY, et al. Less systemic cytokine response in patients following microendoscopic versus open lumbar discectomy[J]. J Orthop Res, 2005, 23(2):406-411.
4 . Clark JG, Abdullah KG, Steinmetz MP, et al. Minimally invasive versus open cervical foraminotomy:a systematic review[J].Global Spine J, 2011, 1(1):9-14.
5 . Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses:the PRISMA statement[J]. Ann Intern Med, 2009, 151(4):264-269.
6 . Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0[J]. Cochrane Collaboration,2011, 17(4):535.
7 .陈会平.经皮椎间孔镜椎间盘切除术与椎板开窗椎间盘切除术治疗老年腰椎间盘突出症的近期疗效比较[J].颈腰痛杂志,2018, 39(4):522-523.
8 .金丹杰,徐南伟,赵国辉,等.经皮椎间孔镜与椎板开窗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[J].中国微创外科杂志, 2017, 17(6):491-494.
9 . Ding ZM, Tao YQ. Clinical outcomes of percutaneous transforaminal endoscopic discectomy versus fenestration discectomy in patients with lumbar disc herniation[J]. J Int Transl Med,2017, 5(1):29-33.
10 .江加义,吴波,长安定,等.经皮椎间孔镜技术与传统椎板间开窗髓核摘除术的疗效比较[J].临床医学, 2017, 37(6):67-69.
11 .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].临床研究, 2016, 51(1):32-34.
12 .王诗成,潘磊,黄必留,等.椎间孔镜和小切口手术治疗腰椎间盘突出症的比较[J].实用骨科杂志, 2015, 21(4):293-296.
13 . Pan L, Zhang P, Yin Q. Comparison of tissue damages caused by endoscopic lumbar discectomy and traditional lumbar discectomy:A randomised controlled trial[J]. Int J Surg, 2014, 12(5):534-537.
14 .王鸿晨,叶猛,张伟学,等.经皮椎间孔镜治疗腰椎间盘突出症的疗效分析[J].临床和实验医学杂志, 2014, 13(5):385-387.
15 .赵采花,汤逊,史志江,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].中国疼痛医学杂志,2014, 20(1):60-63.
16 . Ruetten S, Komp M, Merk H, et al. Recurrent lumbar disc herniation after conventional discectomy a prospective, randomized study comparing full-endoscopic interlaminar and transforaminal versus microsurgical revision[J]. J Spinal Disord Tech, 2009, 22:122-129.
17 . Ruetten S, Komp M, Merk H, et al. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique[J]. Spine, 2008, 33(9):931-939.
18 . Mayer HM, Brock M. Percutaneous endoscopic discectomy:surgical technique and preliminary results compared to microsurgical discectomy[J]. J Neurosurg, 1993, 78(2):216-225.
19 . Liu XY, Yuan SM, Tian YH, et al. Comparison of percutaneous endoscopic transforaminal discectomy, microendoscopic discectomy, and microdiscectomy for symptomatic lumbar disc herniation:minimum 2 year follow-up results[J]. J Neurosurg Spine, 2018, 5(1):1-9.
20 .王翀,姜飞,宋兴华,等.经皮椎间孔镜TESSYS技术与开放手术治疗腰椎间盘突出症疗效及安全性比较[J].新疆医科大学学报, 2017, 40(10):1289-1292.
21 .禤天航,刘效仿,曹正霖,等.经皮椎间孔镜与椎板开窗髓核摘除术治疗复发性腰椎间盘突出症的疗效比较[J].中国骨与关节损伤杂志,2016, 31(9):972-974.
22 . Pan Z, Ha Y, Yi S, et al. Efficacy of transforaminal endoscopic spine system(TESSYS)technique in treating lumbar disc herniation[J]. Med Sci Monit, 2016, 22:530-539.
23 . Ahn SS, Kim SH, Kim DW, et al. Comparison of outcomes of percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy for young adults:a retrospective matched cohort study[J]. World Neuro Surg, 2016, 86(2):250-258.
24 .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(6):868-871.
25 . Chen HC, Lee CH, Li W, et al. Comparison of percutaneous endoscopic lumbar discectomy and open lumbar surgery for adjacent segment degeneration and recurrent disc herniation[J]. Neurol Res Int, 2015, 2015:791943.
26 .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.
27 .杨林,马学龙,石立刚,等. TESSYS技术与开放手术治疗腰椎间盘突出症的效果及安全性比较[J].临床研究, 2013, 20(36):49-52.
28 . Lee DY, Shim CS, Ahn Y, et al. Comparison of percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy for recurrent disc herniation[J]. J Korean Neurosurg Soc, 2009, 46:515-521.
29 . Kim MJ, Lee SH, Jung ES, et al. Targeted percutaneous transforaminal endoscopic diskectomy in 295 patients:comparison with results of microscopic diskectomy[J]. Surgical Neurology, 2007, 68(6):623-631.
30 . Lee SH, Chung SE, Ahn Y, et al. Comparative radiologic evaluation of percutaneous endoscopic lumbar discectomy and open microdiscectomy:a matched cohort analysis[J]. Mt Sinai J Med, 2006, 73(5):795-801.
31 . Yeung AT. Minimally invasive disc surgery with the yeung endoscopic spine system(YESS)[J]. Surg Technol Int, 1999, 8:267-277.
32 . Hoogland T, Schubert M, Miklitz B, et al. Transforaminal posterolateral endoscopic discectomy with or without the combination of a low-dose chymopapain:a prospective randomized study in 280 consecutive cases[J]. Spine(Phila Pa1976), 2006, 31(24):E890-E897.
33 . Hoogland T, van den Brekel-Dijikstra K, Schubert M, et al.Endoscopic transforaminal discectomy for recurrent lumbar disc herniation:a prospective, cohort evaluation of 262 consecutive cases[J]. Spine(Phila Pa 1976), 2008, 33(9):973-978.
2 . Kim DY, Lee SH, Chung SK, et al. Comparison of multifidus muscle atrophy and trunk extension muscle strength percutaneous versus open pedicle screw fixation[J]. Spine, 2005, 30(1):123-129.
3 . Huang TJ, Hsu RW, Li YY, et al. Less systemic cytokine response in patients following microendoscopic versus open lumbar discectomy[J]. J Orthop Res, 2005, 23(2):406-411.
4 . Clark JG, Abdullah KG, Steinmetz MP, et al. Minimally invasive versus open cervical foraminotomy:a systematic review[J].Global Spine J, 2011, 1(1):9-14.
5 . Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses:the PRISMA statement[J]. Ann Intern Med, 2009, 151(4):264-269.
6 . Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0[J]. Cochrane Collaboration,2011, 17(4):535.
7 .陈会平.经皮椎间孔镜椎间盘切除术与椎板开窗椎间盘切除术治疗老年腰椎间盘突出症的近期疗效比较[J].颈腰痛杂志,2018, 39(4):522-523.
8 .金丹杰,徐南伟,赵国辉,等.经皮椎间孔镜与椎板开窗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[J].中国微创外科杂志, 2017, 17(6):491-494.
9 . Ding ZM, Tao YQ. Clinical outcomes of percutaneous transforaminal endoscopic discectomy versus fenestration discectomy in patients with lumbar disc herniation[J]. J Int Transl Med,2017, 5(1):29-33.
10 .江加义,吴波,长安定,等.经皮椎间孔镜技术与传统椎板间开窗髓核摘除术的疗效比较[J].临床医学, 2017, 37(6):67-69.
11 .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].临床研究, 2016, 51(1):32-34.
12 .王诗成,潘磊,黄必留,等.椎间孔镜和小切口手术治疗腰椎间盘突出症的比较[J].实用骨科杂志, 2015, 21(4):293-296.
13 . Pan L, Zhang P, Yin Q. Comparison of tissue damages caused by endoscopic lumbar discectomy and traditional lumbar discectomy:A randomised controlled trial[J]. Int J Surg, 2014, 12(5):534-537.
14 .王鸿晨,叶猛,张伟学,等.经皮椎间孔镜治疗腰椎间盘突出症的疗效分析[J].临床和实验医学杂志, 2014, 13(5):385-387.
15 .赵采花,汤逊,史志江,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].中国疼痛医学杂志,2014, 20(1):60-63.
16 . Ruetten S, Komp M, Merk H, et al. Recurrent lumbar disc herniation after conventional discectomy a prospective, randomized study comparing full-endoscopic interlaminar and transforaminal versus microsurgical revision[J]. J Spinal Disord Tech, 2009, 22:122-129.
17 . Ruetten S, Komp M, Merk H, et al. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique[J]. Spine, 2008, 33(9):931-939.
18 . Mayer HM, Brock M. Percutaneous endoscopic discectomy:surgical technique and preliminary results compared to microsurgical discectomy[J]. J Neurosurg, 1993, 78(2):216-225.
19 . Liu XY, Yuan SM, Tian YH, et al. Comparison of percutaneous endoscopic transforaminal discectomy, microendoscopic discectomy, and microdiscectomy for symptomatic lumbar disc herniation:minimum 2 year follow-up results[J]. J Neurosurg Spine, 2018, 5(1):1-9.
20 .王翀,姜飞,宋兴华,等.经皮椎间孔镜TESSYS技术与开放手术治疗腰椎间盘突出症疗效及安全性比较[J].新疆医科大学学报, 2017, 40(10):1289-1292.
21 .禤天航,刘效仿,曹正霖,等.经皮椎间孔镜与椎板开窗髓核摘除术治疗复发性腰椎间盘突出症的疗效比较[J].中国骨与关节损伤杂志,2016, 31(9):972-974.
22 . Pan Z, Ha Y, Yi S, et al. Efficacy of transforaminal endoscopic spine system(TESSYS)technique in treating lumbar disc herniation[J]. Med Sci Monit, 2016, 22:530-539.
23 . Ahn SS, Kim SH, Kim DW, et al. Comparison of outcomes of percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy for young adults:a retrospective matched cohort study[J]. World Neuro Surg, 2016, 86(2):250-258.
24 .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(6):868-871.
25 . Chen HC, Lee CH, Li W, et al. Comparison of percutaneous endoscopic lumbar discectomy and open lumbar surgery for adjacent segment degeneration and recurrent disc herniation[J]. Neurol Res Int, 2015, 2015:791943.
26 .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.
27 .杨林,马学龙,石立刚,等. TESSYS技术与开放手术治疗腰椎间盘突出症的效果及安全性比较[J].临床研究, 2013, 20(36):49-52.
28 . Lee DY, Shim CS, Ahn Y, et al. Comparison of percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy for recurrent disc herniation[J]. J Korean Neurosurg Soc, 2009, 46:515-521.
29 . Kim MJ, Lee SH, Jung ES, et al. Targeted percutaneous transforaminal endoscopic diskectomy in 295 patients:comparison with results of microscopic diskectomy[J]. Surgical Neurology, 2007, 68(6):623-631.
30 . Lee SH, Chung SE, Ahn Y, et al. Comparative radiologic evaluation of percutaneous endoscopic lumbar discectomy and open microdiscectomy:a matched cohort analysis[J]. Mt Sinai J Med, 2006, 73(5):795-801.
31 . Yeung AT. Minimally invasive disc surgery with the yeung endoscopic spine system(YESS)[J]. Surg Technol Int, 1999, 8:267-277.
32 . Hoogland T, Schubert M, Miklitz B, et al. Transforaminal posterolateral endoscopic discectomy with or without the combination of a low-dose chymopapain:a prospective randomized study in 280 consecutive cases[J]. Spine(Phila Pa1976), 2006, 31(24):E890-E897.
33 . Hoogland T, van den Brekel-Dijikstra K, Schubert M, et al.Endoscopic transforaminal discectomy for recurrent lumbar disc herniation:a prospective, cohort evaluation of 262 consecutive cases[J]. Spine(Phila Pa 1976), 2008, 33(9):973-978.