经后入路单侧双通道脊柱内镜术与颈椎前路椎间盘切除融合术治疗神经根型颈椎病效果的Meta分析

Efficacy of posterior unilateral biportal endoscopy versus anterior cervical decompression and fusion in the treatment of cervical spondylotic radiculopathy: a meta-analysis

中文关键词:  单侧双通道内镜  颈椎前路椎间盘切除融合术  神经根型颈椎病  Meta分析

英文关键词:Unilateral biportal endoscopy  Anterior cervical discectomy and fusion  Cervical spondylotic radiculopathy  Meta analysis

中文摘要:

  【摘要】 目的：比较经后入路单侧双通道脊柱内镜术（unilateral biportal endoscopic，UBE）与颈椎前路椎间盘切除融合术（anterior cervical discectomy and fusion，ACDF）治疗神经根型颈椎病效果的临床疗效。方法：筛选PubMed、EMBASE、中国知网（CNKI）、中国生物医学文献数据库（CBM）、万方数据库至2025年4月前发表的关于UBE与ACDF技术治疗神经根型颈椎病的研究，由2位研究员筛选文献、提取资料并评价纳入研究的偏倚风险后，采用RevMan 5.4软件对纳入文献进行Meta分析。结果指标包括切口长度、手术时间、住院时间、术中出血量、术后上肢或颈部疼痛视觉模拟量表（visual analogue scale，VAS）评分、术后颈部功能障碍指数（neck disability index，NDI）及并发症发生率。结果：共纳入3篇回顾性研究和1篇前瞻性研究，UBE组共128例患者，ACDF组共140例患者。Meta分析结果显示，UBE组切口长度较ACDF组短[MD=-3.74，95%CI（-3.85， -3.62），P<0.05]，手术时间较ACDF组短[MD=14.09，95%CI（4.27，23.91），P<0.05]，住院时间较ACDF短[MD= -1.52，95%CI（-2.38，-0.66），P<0.05]，术中出血量较ACDF组少[MD=-40.32，95%CI（-65.76，-14.87），P<0.05]。两组患者术后3个月上肢痛VAS评分[MD=-0.25，95%CI（-0.52，0.03），P=0.08]、术后3个月颈部疼痛VAS评分[MD=-0.13，95%CI（-0.50，0.23），P=0.47]、术后NDI[MD=-0.44，95%CI（-1.84，0.97），P=0.54]、术后并发症[MD=0.51，95%CI（0.23，1.12），P=0.09]比较，差异均无统计学意义（P>0.05）。结论：UBE与ACDF术后均能有效缓解颈部及上肢痛，但UBE具有切口长度更短、手术时间更短、住院时间更短、出血量更少的优势。

英文摘要:

  【Abstract】 Objectives: To compare the clinical efficacies of posterior unilateral biportal endoscopic(UBE) surgery and anterior cervical discectomy and fusion(ACDF) in treating cervical spondylotic radiculopathy. Methods: A comprehensive review of studies published in PubMed, EMBASE, CNKI, CBM and Wanfang Data up to April 2025 was performed. The studies focused on UBE and ACDF for cervical spondylotic radiculopathy. Two researchers independently screened studies, extracted data, assessed bias risks, and used RevMan 5.4 software for meta-analysis. The outcome indicators included incision length, operative time, hospital stay, intraoperative blood loss, postoperative upper limb/neck pain visual analogue scale(VAS) scores, postoperative neck disability index(NDI), and complication rates. Results: Four studies(three retrospective, one prospective) were included, covering 128 UBE patients and 140 ACDF patients. Meta-analysis showed that UBE group had shorter incisions[MD=-3.74, 95%CI(-3.85, -3.62), P<0.05], shorter surgical time[MD=14.09，95%CI(4.27，23.91), P<0.05], shorter hospital stays[MD=-1.52, 95%CI(-2.38, -0.66), P<0.05], and less intraoperative bleeding[MD=-40.32, 95%CI(-65.76, -14.87), P<0.05] than ACDF group. However, no significant differences were found in postoperative 3-month upper limb pain VAS scores[MD=-0.25, 95%CI(-0.52, 0.03), P=0.08], postoperative 3-month upper neck pain VAS scores[MD=-0.13, 95%CI(-0.50, 0.23), P=0.47], postoperative 3-month NDI[MD=-0.44, 95%CI(-1.84, 0.97), P=0.54], and complications[MD=0.51, 95%CI(0.23, 1.12), P=0.09](all P>0.05). Conclusions: Both UBE and ACDF can effectively relieve neck and upper limb pain, but UBE has advantages in shorter incisions, shorter surgical and hospital stays, and less bleeding.