经椎间孔硬膜外注药与经椎板硬膜外注药治疗腰骶根性疼痛疗效对比的Meta分析

Comparison of outcome of the transforaminal vs interlaminar epidural steroids injection for patients with lumbosacral radicular pain: a meta-analysis

中文关键词:  腰骶神经根性疼痛  经椎间孔注药  经椎板注药  硬膜外  Meta分析

英文关键词:Transforaminal  Interlaminar  Ｅpidural steroids injection  Ｌumbosacral radicular pain  Ｍeta-anlysis

中文摘要:

  【摘要】 目的：系统评价经椎间孔硬膜外注药（TFESI）与经椎板硬膜外注药（ILESI）治疗腰骶神经根性疼痛疗效的差异。方法：计算机检索1990年1月~2014年7月Pubmed、Medline、Embase以及Ovid电子数据库，搜集关于比较TFESI和ILESI治疗腰骶神经根性疼痛的随机对照试验（RCT）研究，制定严格的纳入和排除标准，由两位研究人员独立筛选出符合标准的文献，根据Cochrane手册的改良Jadad量表进行方法学质量评价，并利用Revman 5.3进行Meta分析。结果：初筛共378篇文献，最后纳入5篇文献、199例患者，其中行TFESI 102例，行ILESI 97例。文献质量1篇为5分，2篇为6分，2篇为7分；4篇语种为英文，1篇为法文。Meta分析结果显示：在缓解腰骶神经根性疼痛上，TFESI在术后2周[MD=-1.77，95%CI（-2.95，-0.59），P＜0.01]、1～3个月[MD=18.77，95%CI（4.54，33.0），P=0.01]及6个月[MD=-1.08，95%CI（-1.53，-0.64），P＜0.05]时的疗效优于ILESI，在术后1个月脊柱柔软度改善无明显差异[腰椎活动度（schober index）：MD=0.07，95%CI（-0.42，0.57），P＞0.05；指-地距离（finger-to-floor）：MD=1.21，95%CI （-6.41，8.82），P＞0.05）]。结论：在缓解腰骶神经根性疼痛上，TFESI在术后6个月内疗效均优于ILESI，但在改善脊柱柔软度上两种方法无明显差异。

英文摘要:

  【Abstract】 Objectives: To assess the efficacy of lumbar transforaminal epidural steroids injection(TFESI) vs interlaminar epidural steroids injection(ILESI) for lumbosacral radiculopathy. Methods: The available literature of comparison between the transforaminal and interlaminar epidural steroids injection for low back and radicular pain was reviewed. Data sources included relevant literature of the English language identified in Pubmed, Medline, Embase and Ovid data bases from 1990 to 2014. The randomized controlled trials(RCT) were collected based on the strict criterion of inclusions and exclusions. The included articles were evaluated by using the Corchrane Handbook and the Revman 5.3 was used for meta-anlysis. Results: The initial research included 378 papers. After screening, 5 RCTs were recruited for analysis. According to the revised Jadad score, the score of 2 articles was 6, 2 was 7 and 1 was 5. Among the 199 patients, 102 undergoing TFESI and 97 undergoing ILESI were included. The meta analysis showed there was statistically significance between TFESI and ILESI at 2 weeks[MD=-1.77, 95%CI(-2.95, -0.59), P＜0.01], 1-3 months[MD=18.77, 95%CI([4.54, 33.0), P=0.01] and 6 months after injection[MD=-1.08, 95%CI(-1.53, -0.64), P＜0.05]. But the schober index(MD=0.07, 95%CI(-0.42, 0.57), P＞0.05) and finger-to-floor distance[MD=1.21, 95%CI(-6.41, 8.82), P＞0.05] showed no significant differences between the two groups at 1 month after injection. Conclusions: The TFESI has better outcome than ILESI in 6 months after injection for lumbosacral radicular pain, but no significant difference on the improvement of back stiffness at 1 month is noted.