腰椎间盘突出有限切除术与次全切除术临床效果与术后原位再突出率的Meta分析

Meta-analysis of the clinical effects and postoperative re-protrusion rate of limited resection and subtotal resection of lumbar intervertebral disc herniation

中文关键词:  腰椎间盘突出症  有限切除术  次全切除术  Meta分析

英文关键词:Lumbar disc herniation  Limited discectomy  Subtotal discectomy  Meta-analysis

中文摘要:

  【摘要】 目的：通过Meta分析评价有限切除术（limited discectomy）与次全切除术（subtotal discectomy）治疗腰椎间盘突出症的临床效果与术后原位再突出率。方法：检索PubMed、Cochrane Library、Web of Science、Embase、中国知网（China National Knowledge Infrastructure，CNKI）、万方、维普数据库自建库至2025年8月关于有限切除术和次全切除术治疗腰椎间盘突出症的相关临床对照研究文献。提取纳入研究的结局指标数据，包括手术时间、术中出血量、住院时间、腰痛视觉模拟量表（visual analogue scale，VAS）评分、下肢痛VAS评分、椎间盘再突出率、并发症。提取数据后通过Review Manager 5.3软件进行Meta分析。采用Cochrane风险评估工具对随机对照实验（randomized controlled trials，RCT）文献进行评价，回顾性研究及前瞻性研究则用纽卡斯尔-渥太华量表（Newcastle-Ottawa Scale，NOS）进行质量评价。结果：共纳入文献14篇，均为英文，其中3篇为RCT，5篇前瞻性研究，6篇回顾性研究。文献质量均为中高质量。总样本量1864例，有限切除组患者857例，次全切除组患者1007例。Meta分析结果显示：有限切除组手术时间短于次全切除组[MD=-8.72，95%CI（-15.76， -1.68），P=0.02]；术后1年、2年有限切除组腰痛VAS评分较次全切除组明显减轻[MD=-0.30，95%CI（-0.44， -0.17），P＜0.0001]、[MD=-0.25，95%CI（-0.36，-0.14），P＜0.00001]；术后2年有限切除组下肢疼痛VAS评分较次全切除组减轻明显[MD=-0.20，95%CI（-0.31，-0.09），P=0.0005]；两组术后原位再突出率[OR=1.13，95%CI（0.77，1.67），P=0.53]、术后并发症[OR=0.82，95%CI（0.59，1.14），P=0.23]、术中失血量[MD=10.10，95%CI（-18.03，38.22），P=0.48]、住院时间[MD=-0.02，95%CI（-0.12，0.07），P=0.63]均无统计学差异。结论：腰椎间盘突出症两种切除术式术后原位再突出风险和并发症无明显差异。接受有限切除术的患者在腰痛和下肢疼痛缓解、手术时间方面略有优势，但需在更大样本量的RCT中进一步验证。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical outcomes and postoperative reherniation rates of limited discectomy versus subtotal discectomy for lumbar disc herniation through a meta-analysis. Methods: A systematic search was conducted in the PubMed, Cochrane Library, Web of Science, Embase, China National Knowledge Infrastructure(CNKI), Wanfang, and VIP databases from their inception until August 2025 for controlled clinical trial studies about limited discectomy and subtotal discectomy in the treatment of lumbar disc herniation. Data of outcomes were extracted from the included studies, such as operative time, intraoperative blood loss, length of hospital stay, low back pain visual analogue scale(VAS) score, lower limb pain VAS score, disc reherniation rate, and complications. A meta-analysis was performed using RevMan 5.3 software. The Cochrane Risk of Bias tool was used to assess randomized controlled trials(RCT), while the Newcastle-Ottawa scale(NOS) was applied to evaluate retrospective and prospective studies. Results: A total of 14 English-language studies were included, comprising 3 RCTs, 5 prospective studies, and 6 retrospective studies. The quality of the included studies were all medium and high. The total sample size was 1,864 patients, with 857 patients in the limited discectomy group and 1,007 patients in the subtotal discectomy group. Meta-analysis results indicated: The operative time in the limited discectomy group was significantly shorter than that in the subtotal discectomy group[MD=-8.72, 95%CI(-15.76, -1.68), P=0.02]. At 1-year and 2-year follow-ups, the low back pain VAS score was significantly lower in the limited discectomy group compared with the subtotal discectomy group[1-year: MD=-0.30, 95%CI(-0.44, -0.17), P<0.0001; 2-year: MD=-0.25, 95%CI(-0.36, -0.14), P<0.00001]. At 2-year follow-up, the lower limb pain VAS score was significantly lower in the limited discectomy group compared with the subtotal discectomy group[MD=-0.20, 95%CI(-0.31, -0.09), P=0.0005]. No statistically significant difference was found between the two groups in the postoperative reherniation rate[OR=1.13, 95%CI (0.77, 1.67), P=0.53], incidence of postoperative complications[OR=0.82, 95%CI(0.59, 1.14), P=0.23], intraoperative blood loss[MD=10.10, 95%CI(-18.03, 38.22), P=0.48], or in the length of hospital stay[MD=-0.02, 95%CI(-0.12, 0.07), P=0.63]. Conclusions: The meta-analysis indicates that there is no significant difference in the risk of postoperative reherniation or complications between the two discectomy techniques for lumbar disc herniation. Patients undergoing limited discectomy experience slightly better outcomes in terms of low back and lower limb pain relief, as well as shorter operative time, which requires further validation through large-scale RCTs.