Barricaid纤维环闭合装置对腰椎髓核摘除术后复发和再手术率影响的Meta分析

Barricaid annular closure device for reduction of symptomatic reherniation and reoperation after lumbar discectomy: systematic review and Meta-analysis

中文关键词:  Barricaid纤维环闭合装置  腰椎间盘突出症  腰椎髓核摘除术  再手术

英文关键词:Barricaid annular closure device  Lumbar disc herniation  Reherniation  Reoperation

中文摘要:

  【摘要】 目的：通过Meta分析法探究Barricaid纤维环闭合装置（annular closure device，ACD）对腰椎髓核摘除术术后复发和再手术率的影响。方法：通过检索Medline、EMbase、PubMed和Cochrane Central Register数据库，纳入包含采用Barricaid ACD修复腰椎髓核摘除术后椎间盘缺损预防突出复发和再手术率的文献，检索时限为建库至2020年8月。由2名研究员独立筛选文献、评价纳入研究的偏倚风险后，提取腰椎间盘切除术中使用Barricaid ACD（ACD组）与未使用Barricaid ACD（对照组）的术后2年内有关突出复发和再手术率的相关数据，通过RevMan 5.3 软件进行Meta分析；研究ACD组和对照组术后3个月、1年、2年、3年、4年内的突出复发和再手术率，探讨ACD对突出复发和再手术率的影响。结果：共纳入14篇文献，其中6篇文献进行了术后2年内突出复发的分析，共计873例行腰椎髓核摘除术的患者，其中ACD组407例，对照组466例，Meta分析结果显示ACD组术后2年内突出复发明显降低（OR：0.35；95%CI：0.22，0.55；I2=0%；P<0.00001）。4篇文章进行了术后2年内再手术率的分析，共计797例患者，其中ACD组377例，对照组420例，Meta分析结果显示ACD组术后2年内再手术率明显降低（OR：0.46；95%CI：0.29，0.74；I2=0%；P=0.001）。10篇研究汇总统计了550例腰椎髓核摘除术后的患者，其中ACD组272例，对照组278例，ACD组术后3个月、1年、2年、3年、4年内的再手术率和术后3个月、1年、2年、3年内的突出复发率均小于对照组。结论：腰椎髓核摘除术后采用Barricaid ACD修补椎间盘缺损可以降低术后复发率和再手术率。

英文摘要:

  【Abstract】 Objectives: To explore the effect of annular closure device(ACD) on the symptomatic reherniation and reoperation rate after lumbar discectomy(LD) by Meta-analysis. Methods: Databases including MEDLINE, EMBASE, PubMed, and Cochrane Central Register were searched for literature on the prevention of symptomatic reherniation and reduction of reoperation rate of disc herniation after lumbar discectomy by using Barricaid ACD. Two researchers independently screened the literature and evaluated the risk of bias in the included studies. After that, relevant data about the symptomatic reherniation and reoperation rate of lumbar disc herniation within 2 years after operation were extracted using ACD(ACD group) or not(control group). A Meta-analysis by Revman 5.3 software was adopted to analyze the symptomatic reherniation and reoperation rates in ACD group and control group within 3 months, 1 year, 2 years, 3 years and 4 years after operation, retrospectively. Results: A total of 14 literatures were included, of which 6 were analyzed for the recurrence of protrusion within 2 years after operation. And a total of 873 cases of patients were after lumbar discectomy, including 407 cases in ACD group and 466 cases in control group. The results of Meta-analysis showed that: the symptomatic reherniation of protrusion within 2 years after operation in ACD group was significantly reduced (OR: 0.35; OR: 0.05; OR: 0.05); 95%CI: 0.22, 0.55; I2=0%; P<0.00001), and that the reoperation rate within 2 years after operation in ACD group was significantly lower than that in control group (OR: 0.46; P<0.05); 95%CI: 0.29, 0.74; I2=0%; P=0.001). Ten studies collected 550 patients after lumbar discectomy, including 272 patients in ACD group and 278 patients in control group. The reoperation rate within 3 months, 1 year, 2 years, 3 years and 4 years after operation and the symptomatic reherniation rate within 3 months, 1 year, 2 years and 3 years after operation in ACD group were lower than those in the control group. Conclusions: Compared with lumbar discectomy, lumbar discectomy with the Barricaid annulus closure device significantly reduced the symptomatic reherniation rate and reoperation in patients.