单侧双通道与单通道脊柱内镜下手术治疗腰椎管狭窄症的Meta分析

Meta analysis of operations under unilateral biportal endoscopy and uniportal endoscopy in the treatment of lumbar spinal stenosis

中文关键词:  腰椎管狭窄症  单侧双通道脊柱内镜  单通道脊柱内镜  Meta分析

英文关键词:Lumbar spinal canal stenosis  Unilateral biportal endoscopy  Uniportal endoscopy  Meta analysis

中文摘要:

  【摘要】 目的：通过Meta分析比较单侧双通道脊柱内镜（unilateral biportal endoscopy，UBE）与单通道脊柱内镜（uniportal endoscopy，UE）治疗腰椎管狭窄症（lumbar spinal stenosis，LSS）的疗效。方法：检索PubMed、Cochrane Libmry、Web of science、Embase、Medline、中国知网（CNKI）、万方数据（WanFang）、维普（VIP）数据库中关于UBE和UE下手术治疗LSS的临床对照研究文献，检索时限为自数据库建库至2024年5月，采用纽卡斯尔-渥太华（Newcastle-Ottawa scale，NOS）对纳入的研究进行质量评价。按手术方法分为UBE组和UE组。提取纳入研究的结局指标数据，包括术后腰痛及腿痛的视觉模拟评分（visual analogue scale，VAS）、Oswestry功能障碍指数（Oswestry disability index，ODI）、手术时间、术中出血量、住院时间、并发症、硬膜囊面积，通过Review Manager 5．3软件进行Meta分析。结果：共纳入15篇文献，1篇前瞻队列性研究，14篇回顾性研究，NOS评价均为中高质量。总样本量1277例，其中UBE组患者650例，UE组患者627例。Meta分析结果显示，UEB组和UE组手术时间有统计学差异，UBE组手术时间较UE组短[MD=-12.30，95%CI（-20.90，-3.71），P=0.005]；在术中失血量[MD=7.41，95%CI（-0.55，15.31），P=0.07]、住院时间[MD＝0.02，95%CI（-0.09,0.14），P=0.71]、术后背部疼痛VAS评分[MD＝-0.22，95%CI（-0.45，0.02），P=0.07]、术后疼痛下肢VAS评分[MD＝-0.18，95%CI（0.39，0.02），P=0.08]、术后ODI[MD＝-0.91，95%CI（-2.22，0.39），P=0.17]、术后并发症发生率[OR＝0.75，95%CI（0.46，1.24），P=0.27]、术前硬膜囊面积[MD＝0.37，95%CI（-3.18，2.44），P=0.80]等方面的差异均无统计学意义；UBE组术后硬膜囊面积扩张显著性大于UE组[MD＝-12.51，95%CI（7.44，17.59），P＜0.00001]。结论：UBE及UE下手术治疗LSS均可取得显著临床疗效，在手术时间、椎管减压程度方面，UBE较UE更加有优势。

英文摘要:

  【Abstract】 Objectives: To compare the efficacies of operations under unilateral biportal endoscopy(UBE) and uniportal endoscopy(UE) in the treatment of lumbar spinal stenosis(LSS) with meta analysis. Methods: The clinical controlled studies of UBE and UE in the treatment of LSS were searched in PubMed, Cochrane Library, Web of science, Embase, Medline, CNKI, Wanfang, and VIP database from their establishments to May 2024. Newcastle-Ottawa scale(NOS) was used to evaluate the quality of the included studies. Outcome data including visual analogue scale(VAS) score of lower back and leg pain, Oswestry disability index(ODI), operative time, intraoperative blood loss, length of hospital stay, complications, and dural sac area were extracted and analyzed with Review Manager 5.3 software for meta analysis. Results: A total of 15 articles were included, including 1 prospective cohort study and 14 retrospective studies, which were of medium and high quality according to the NOS. The total sample size was 1277, including 650 patients in the UBE group and 627 patients in the UE group. Meta analysis showed that there was a statistical difference in the operative time between the two groups, and the UBE group was shorter[MD=-12.30, 95%CI(-20.90, -3.71), P=0.005]. There was a no statistically significant difference in intraoperative blood loss[MD=7.41, 95%CI(-0.55, 15.31), P=0.07], length of hospital stay[MD=0.02, 95%CI(-0.09, 0.14), P=0.71], postoperative back pain VAS score[MD=-0.22, 95%CI(-0.45, 0.02), P=0.07], postoperative leg pain VAS score[MD=-0.18, 95%CI(0.39, 0.02), P=0.08], ODI[MD=-0.91, 95%CI(-2.22, 0.39), P=0.17], complication rate[OR=0.75, 95%CI(0.46, 1.24), P=0.27], or preoperative dural sac cross-sectional area[MD=0.37, 95%CI(-3.18, 2.44), P=0.80] between the two groups. However, the dural sac area expansion after operation was statistically larger in UBE group than that in UE group[MD=-12.51, 95%CI(7.44, 17.59), P＜0.00001]. Conclusions: Both operations under UBE and UE can achieve significant clinical efficacy in the treatment of LSS, and UBE is superior to UE in operative time and the degree of spinal canal decompression.