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

Percutaneous spinal endoscopy vs traditional open surgery: systematic evaluation and Meta-analysis of operative complication in lumbar disc herniation

中文关键词:  脊柱内镜  腰椎间盘突出症  并发症  Meta分析

英文关键词:Spinal endoscopy  Lumbar disc herniation  Complication  Meta analysis

中文摘要:

  【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。

英文摘要:

  【Abstract】 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.