单侧双通道脊柱内镜与经皮内镜下手术治疗神经根型颈椎病疗效比较的Meta分析

Meta-analysis of efficacy and safety comparisons between unilateral biportal endoscopy and percutaneous endoscopy in the treatment of cervical spondylotic radiculopathy

中文关键词:  神经根型颈椎病  单侧双通道脊柱内镜  经皮内镜  Meta分析

英文关键词:Cervical spondylotic radiculopathy  Unilateral biportal endoscopy  Percutaneous endoscopy  Meta-analysis

中文摘要:

  【摘要】 目的：通过Meta分析比较单侧双通道脊柱内镜（unilateral biportal endoscopy，UBE）与经皮内镜（percutaneous endoscopy，PE）下手术治疗神经根型颈椎病（cervical spondylotic radiculopathy，CSR）的疗效。方法：检索Pubmed、Embase、Cochrane Library、Web of science、中国知网数据库、万方数据库、中国生物医学数据库，自建库截止到２０２5年6月关于UBE和PE治疗CSR的临床预后和并发症的相关研究。采用Cochrane风险评估工具对随机对照试验文献进行评价，纽卡斯尔一渥太华量表（Newcastle-Ottawa scale，NOS）量表对回顾性研究进行评价。提取纳入研究的结局指标数据，包括颈部和上肢疼痛视觉模拟量表（visual analogue scale，VAS）评分、颈部残疾指数（neck disability index，NDI）、手术时间、术中出血量、住院时间、手术切口大小、术前及术后肌酸激酶（serum creatine kinase，CK）、C反应蛋白（C-reactive protein，CRP）和术后并发症。通过Review Manager 5．4软件进行Meta分析。结果：共纳入10篇文献，均为回顾性研究，NOS量表评分6篇8分，3篇7分，1篇为6分，均为中高质量。总样本量782例，其中UBE组388例，PE组394例。Meta分析结果显示，UBE组和PE组手术时间无统计学差异[MD=-6.67，95%CI（-17.47，4.13），P=0.23]；术中出血量PE组明显少于UBE组[MD=10.86，95%CI（0.64，21.07），P=0.04]；两组术后住院时间无统计学差异[MD=0.49，95%CI（-0.00, 0.99），P=0.05]；两组手术切口大小存在统计学差异[MD=7.13，95%CI（1.76，12.50），P=0.009]，PE组手术切口明显小于UBE组；两组术后CK[MD=1.25，95%CI（-5.08，7.75），P=0.70]、CRP[MD=-0.03，95%CI（-0.08, 0.02），P=0.23]无统计学差异；两组术后各个时间点的颈部疼痛VAS评分无统计学差异[MD=-0.07，95%CI（-0.17，0.04），P=0.20]；两组术后第3个月上肢疼痛VAS评分有统计学差异，UBE组低于PE组[MD=-0.14，95%CI（-0.26， -0.01），P=0.03]；术后各时间点NDI[MD=-0.24，95%CI（-0.50，0.02），P=0.07]和术后并发症 [OR=1.02，95%CI（0.51，2.03），P=0.95]无统计学差异。结论：UBE和PE下手术治疗CSR均具有较好的临床疗效和安全性，PE组术中出血量较少，手术切口较小；术后第3个月UBE组较PE组上肢疼痛缓解更好。

英文摘要:

  【Abstract】 Objectives: To compare the efficacy of unilateral biportal endoscopy(UBE) versus percutaneous endoscopy(PE) for treating cervical spondylotic radiculopathy(CSR) using meta-analysis. Methods: A comprehensive search was conducted in PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure(CNKI), Wanfang Database, and China Biomedical Literature Database for studies published since their inceptions up to June 2025 that reported clinical outcomes and complications of UBE and PE in the treatment of CSR. The Cochrane Risk of Bias tool was used to assess randomized controlled trials, while the Newcastle-Ottawa scale(NOS) was applied to evaluate retrospective studies. Outcome indicators were extracted including visual analogue scale(VAS) scores for neck and upper limb pain, neck disability index(NDI), operative time, intraoperative blood loss, length of hospital stay, incision size, preoperative and postoperative serum creatine kinase(CK) and C-reactive protein(CRP) levels, and postoperative complications. Meta-analysis was performed using Review Manager 5.4 software. Results: A total of 10 literatures were included, all of which were retrospective studies, and six studies were 8 points of NOS scores, three studies were 7 points, and one study was 6 point, indicating moderate to high quality. The total sample comprised 782 patients(UBE: n=388; PE: n=394). Meta-analysis revealed no significant difference in operative time between groups[MD= -6.67, 95%CI(-17.47, 4.13), P=0.23]. Intraoperative blood loss was significantly lower in the PE group[MD=10.86, 95%CI(0.64, 21.07), P=0.04]. No significant difference was observed in postoperative length of hospital stay[MD=0.49, 95%CI(-0.00, 0.99), P=0.05]. Incision size was significantly smaller in the PE group[MD=7.13, 95%CI(1.76, 12.50), P=0.009]. There were no significant intergroup differences in postoperative CK[MD=1.25, 95%CI(-5.08, 7.75), P=0.70] or CRP levels[MD=-0.03, 95%CI(-0.08, 0.02), P=0.23]. There was no significant difference in neck pain VAS scores at various timepoints between the two groups[MD=-0.07, 95%CI(-0.17, 0.04), P=0.20]. However, the UBE group was significantly lower in upper limb pain VAS scores at 3 months postoperatively[MD=-0.14, 95%CI(-0.26, -0.01), P=0.03]. No significant differences were found in NDI scores across follow-up periods[MD=-0.24, 95%CI(-0.50, 0.02), P=0.07] or in complication rates[OR=1.02, 95%CI(0.51, 2.03), P=0.95]. Conclusions: Both UBE and PE operations are effective and safe in the treatment of CSR. The PE technique is associated with less intraoperative blood loss and smaller incisions, while UBE provides superior improvement in upper limb pain at the 3-month follow-up.