经皮内窥镜下腰椎间盘切除术治疗复发性腰椎间盘突出症并发症的Meta分析

Percutaneous endoscopic lumbar discectomy for recurrent lumbar disc herniation: a Meta-analysis

中文关键词:  复发性腰椎间盘突出症  经皮内镜  椎间盘切除术  并发症  Meta分析

英文关键词:Recurrent lumbar disc herniation  Percutaneous endoscopy  Discectomy  Complications  Meta-analysis

中文摘要:

  【摘要】 目的：通过Meta分析评价经皮内窥镜下椎间盘切除术（percutaneous endoscopic lumbar discectomy，PELD）治疗复发性腰椎间盘突出症（RLDH）的临床相关并发症发生率，评估手术安全性。方法：计算机检索PubMed、EMbase、The Cochrane Library、CBM、WanFang Data和CNKI数据库，搜集有关PELD治疗RLDH相关并发症的临床研究，检索时限均为建库至2019年8月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后，采用RevMan5.3软件进行Meta分析。结果：共纳入13个临床研究，包括1个随机对照试验和12个队列研究，共计患者1252例。Meta分析显示，PELD手术总体并发症[OR=0.46，95%CI（0.25，0.87），P=0.02]、硬脊膜撕裂发生率[OR=0.16，95%CI（0.05，0.56），P=0.004]低于椎板开窗髓核摘除术（P<0.05），但与MED、MIS-TLIF相比，术后总体并发症发生率、硬脊膜撕裂、神经根损伤、髓核摘除不彻底发生率差异均无统计学意义（P>0.05）。结论：PELD治疗复发性腰椎间盘突出症较椎板开窗髓核摘除术并发症发生率低，安全性较高，在排除影像学腰椎失稳的情况下，是一种较为安全有效的治疗手段。

英文摘要:

  【Abstract】 Objectives: To evaluate the safety and complication rate of percutaneous endoscopic discectomy for recurrent lumbar disc herniation through Meta-analysis. Methods: PubMed, EMbase, The Cochrane Library, CBM, WanFang Data and CNKI databases were searched by computer to collect clinical studies on complications related to percutaneous endoscopic lumbar discectomy for recurrent lumbar disc herniation. The retrieval time was from the establishment of the database to August 2019. The Meta-analysis was performed by Revman 5.3 software after two researchers independently selected literature, extracted data and evaluated the bias risk of the study. Results: A total of 1252 patients were enrolled in 13 clinical studies, including 1 randomized controlled trial and 12 cohort studies. Meta-analysis showed that the overall complications[OR=0.46, 95%CI(0.25, 0.87), P=0.02] and dural tear rate[OR=0.16, 95%CI(0.05, 0.56), P=0.004] of PELD were lower than those of traditional fenestration nucleus pulposus removal(P<0.05), but compared with MED and MIS-TLIF, there were no significant differences in the overall complications, dural tear, nerve root injury and incomplete nucleus pulposus removal rate(P>0.05). Conclusions: PELD has a lower incidence of complications and a higher safety than traditional fenestration nucleus pulposus remova in the treatment of recurrent lumbar disc herniation. PELD is a safe and effective method to treat recurrent lumbar disc herniation without imaging instability.