单侧双通道内镜手术与显微内镜手术治疗腰椎管狭窄症的Meta分析

A Meta-analysis of unilateral biportal endoscopic and micro endoscopic surgery in the treatment of lumbar spinal stenosis

中文关键词:  腰椎管狭窄症  单侧双通道内镜手术  显微内镜手术  Meta分析

英文关键词:Lumbar spinal stenosis  Unilateral biportal endoscopic  Micro endoscopic  Meta-analysis

中文摘要:

  【摘要】 目的：通过Meta分析评价单侧双通道内镜手术（unilateral biportal endoscopic surgery，UBES）与显微内镜手术（micro endoscopic surgery，MES）治疗腰椎管狭窄症的疗效与安全性，为UBES在临床中的推广提供参考。方法：计算机检索万方数据库（Wanfang Database）、中国期刊全文数据库（CNKI）、维普数据库（VIP）、中国生物医学文献数据库（CBM）、PubMed、Web of Science、Embase、Cochrane、Clinical Trials，并通过Google Scholar进行文献补充，搜集所有采用UBES与MES治疗腰椎管狭窄症的对照研究，检索时限从2000年1月1日至2021年3月25日。由2名评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险。提取资料包括手术时间、术中出血量、术后并发症、住院时间，术后2d及术后1周的C反应蛋白量，术后1周内硬脊膜扩张度，术后1～2d、1～3个月、6～9个月和12个月的腰痛和下肢痛视觉模拟评分（visual analogue scale，VAS），术后1周内、1～3个月、6～9个月和12个月的Oswestry功能障碍指数（Oswestry disability index，ODI），术后12个月时的改良Macnab标准评定及欧洲五维健康量表（EuroQol Five Dimensions Questionnaire，5Q-5D）评分。应用纽卡斯尔-渥太华量表（Newcastle-Ottawa scale，NOS）对纳入的队列研究进行质量评价，应用Cochrane偏倚风险评估工具对纳入的随机对照研究进行质量评价。采用Review Manager 5.4.1软件进行Meta分析 ，二分类变量采用优势比（odds ratio，OR）分析，连续性变量采用加权均数差（weighted mean difference，WMD）分析，所有合并数据使用95%可信区间（CI）表示，P＜0.05为差异有统计学意义。结果：共纳入10篇文献，其中高质量文献5篇，中等质量文献5篇，包括4篇随机对照研究、6篇队列研究，共880例患者，其中UBES组407例，MES组473例。Meta分析结果显示，UBES组腰痛VAS评分在术后1～2d[WMD=-1.61，95%CI（-1.91，-1.31），P<0.01]、1～3个月[WMD=-0.90，95%CI（-1.19，-0.61），P<0.01]、6～9个月[WMD=-0.24，95%CI（-0.40，-0.07），P<0.01]时比MES组低，术后下肢痛VAS评分在术后1～2d[WMD=-0.55，95%CI（-0.83，-0.28），P<0.01]、6～9个月[WMD=-0.22，95%CI（-0.35，-0.08），P<0.01]时比MES组低，住院时间[WMD=-2.21，95%CI（-3.50，-0.91），P<0.01]与术后2d及术后1周C反应蛋白量较MES组低，总并发症发生率[OR=0.55，95%CI（0.32，0.96），P=0.03]较MES组低；UBES组术中出血量、手术时间、术后1周硬脊膜扩张度，术后12个月腰痛VAS评分，术后1～3个月与术后12个月下肢痛VAS评分，术后1周内、1～3个月、6～9个月和12个月的ODI，术后12个月时的改良Macnab标准评定与5Q-5D评分，与MES组比较均无统计学差异（P＞0.05）。结论：相较于MES，UBES具有住院时间短、恢复快、手术并发症发生率低、术后炎症反应小等优势，术后12个月随访两者的疗效一致。

英文摘要:

  【Abstract】 Objectives: To evaluate the efficacy and safety of unilateral biportal endoscopic surgery(UBES) and micro endoscopic surgery(MES) in the treatment of lumbar spinal stenosis, and to provide evidence for clinical procedure. Methods: Databases including PubMed, Web of Science, Embase, Cochrane Library, Clinical Trials, CNKI, Wanfang, VIP, and CBM Database were searched, which was supplemented with Google Scholar, and the retrieval period was between January 1, 2000 and March 25, 2021. Two reviewers screened the literature independently, extracted data, and evaluated the risk of bias in the included studies. The literature was screened in strict accordance with the inclusion and exclusion criteria, and the extracted data included operation time, intraoperative bleeding, complications after surgery, hospital stay, the amount of C-reactive protein at 2 days and 1 week after operation, the degree of dural dilatation within 1 week after surgery, visual analogue scale(VAS) scores of low back and lower limb pain at 1-2 days, 1-3 months, 6-9 months and 12 months after surgery, Oswestry disability index(ODI) at 1 week, 1-3 months, 6-9 months and 12 months after surgery, modified Macnab criteria at 12 months after surgery, and EuroQol Five Dimensions Questionnaire(5Q-5D) score at 12 months after surgery. The Newcastle-Ottawa scale(NOS) was used to evaluate the quality of the included cohort studies, and the Cochrane risk of bias assessment tool was used to evaluate the quality of the included randomized controlled studies. The Review Manager 5.4.1 software was used for data merging, the binary variables were analyzed by odds ratio(OR), and the continuous variables were analyzed by weighted mean difference(WMD). All merged data were 95% confidence interval(CI), which indicates that P<0.05 with a statistically significant difference. Results: There were 10 studies(4 randomized controlled trial, 6 cohort studies) involving 880 patients. A total of 5 high-quality articles and 5 medium-quality articles were included. Among them, 407 patients were treated by UBES and 473 were treated by MES. The results of Meta-analysis showed: the VAS score of postoperative low back pain in the UBES group was lower than that of the MES group at 1-2 days[WMD=-1.61, 95%CI(-1.91, -1.31), P<0.01], 1-3 months [WMD=-0.90, 95%CI(-1.19, -0.61), P<0.01], 6-9 months[WMD=-0.24, 95%CI(-0.40, -0.07), P<0.01]; The VAS score of lower limb pain was lower than that of the MES group at 1-2 days[WMD=-0.55, 95%CI(-0.83, -0.28), P<0.01], 6-9 months[WMD=-0.22, 95%CI(-0.35, -0.08), P<0.01] after surgery; The length of hospital stay[WMD=-2.21, 95%CI(-3.50, -0.91), P<0.01] and the C-reactive protein at 2 days and 1 week after surgery in the UBES group was lower than that of the MES group; the total complications of the UBES group [OR=0.55, 95%CI(0.32, 0.96), P=0.03] were lower than that of the MES group. There were no statistical differences between the two groups in terms of intraoperative blood loss, dural expansion indexes, VAS scores of low back pain at 12 months after surgery, VAS scores for lower limb pain at 1-3 months and 12 months after operation, as well as ODI within 1 week, 1-3 months, 6-9 and 12 months after operation, modified Macnab criteria, operation time, and 5Q-5D scores(P>0.05). Conclusions: Compared with MES, UBES has the advantages of shorter hospital stay, faster recovery, lower incidence of surgical complications, and less postoperative inflammation. However, the efficacy of the two groups is similar in the 12 months follow-up.