脊柱内镜下可视化成形术与传统成形术治疗腰椎退行性疾病疗效比较的Meta分析

A meta-analysis of the efficacies of visualized foraminoplasty vs traditional foraminoplasty under spinal endoscopy in the treatment of lumbar degenerative disease

中文关键词:  腰椎退行性疾病  经皮脊柱内镜下腰椎间盘切除术  可视化成形  Meta分析

英文关键词:Lumbar degenerative disease  Percutaneous endoscopic lumbar discectomy  Visualized foraminoplasty  Meta-analysis

中文摘要:

  【摘要】 目的：系统比较脊柱内镜下可视化成形术与传统成形术治疗腰椎退行性疾病的临床疗效。方法：计算机检索PubMed、维普、中国知网和万方数据等数据库从建库至2023年12月发表的脊柱内镜下可视化成形术（可视化组）与传统成形术（传统成形组）治疗腰椎退行性疾病疗效比较的临床对照研究，采用纽卡斯尔-渥太华量表（Newcastle－Ottawa scale，NOS）对纳入的回顾性病例对照研究进行质量评价，采用Cochrane偏倚风险评估工具对纳入的前瞻性随机对照研究进行偏倚风险评估。统计两组的主要疗效指标[手术时间、C型臂X线机透视次数、住院时间、并发症、疼痛视觉模拟评分（visual analogue scale，VAS）、Oswestry功能障碍指数 （Oswestry disability index，ODI）]，对符合纳入标准的文献采用RevMan 5.3软件进行Meta分析。结果：共纳入4篇前瞻性研究和12篇回顾性研究文献，NOS评价回顾性研究均为中高质量，Cochrane偏倚风险评估显示前瞻性研究偏倚低风险。共纳入1239例患者，其中可视化组642例，传统成形组597例。Meta分析结果显示，可视化组C型臂X线机透视次数较传统成形组更少（MD=-8.16，95%CI：-10.06～-6.27，P<0.001），手术时间更短（MD=-17.18，95%CI：-21.48～-12.88，P<0.001）；两组患者术后住院时间、VAS评分、ODI改善程度、术后并发症等方面比较均无统计学差异（P>0.05）。结论：脊柱内镜下可视化成形术与传统成形术治疗腰椎退行性疾病均能取得良好的临床疗效，但可视化成形术手术时间较传统成形术更短，C型臂X线机透视次数更少。

英文摘要:

  【Abstract】 Objectives: To systematically compare the clinical efficacies of visualized endoscopic foraminoplasty and traditional foraminoplasty in the treatment of degenerative lumbar diseases. Methods: Literature of clinical comparative studies of visualized foraminoplasty(visualized group) and traditional foraminoplasty(traditional group) in the treatment of lumbar degenerative diseases were searched from the databases such as CNKI, VIP, WANFANG DATA, and PubMed from the inception to December 2023. The Newcastle-Ottawa scale(NOS) was used to evaluate the quality of the included retrospective case-control studies, and the Cochrane Risk of Bias Tool was used to assess the risk of bias in the included prospective randomized controlled studies. The main efficacy indicators of the two groups[operative time, C-arm fluoroscopy frequency, hospitalization time, complications, visual analogue scale(VAS) score, and Oswestry disability index(ODI)] were statistically analyzed. RevMan 5.3 software was used for Meta-analysis of the literature that met the inclusion criteria. Results: A total of 4 prospective studies and 12 retrospective studies were included. The NOS evaluation indicated that the retrospective studies were of medium to high quality, and the Cochrane risk of bias assessment showed a low risk of bias in the prospective studies. A total of 1, 239 patients were included, with 642 in the visualized group and 597 in the traditional group. Meta-analysis results showed that the the visualized group had fewer C-arm X-ray fluoroscopies(MD=-8.16, 95%CI: -10.06--6.27, P<0.001) and shorter operative time(MD=-17.18, 95%CI: -21.48--12.88, P<0.001) compared to the traditional group. There were no statistically significant differences between the two groups in terms of hospitalization time, VAS score, ODI improvement, or postoperative complications(P>0.05). Conclusions: Both visualized endoscopic foraminoplasty and traditional endoscopic foraminoplasty can achieve good clinical efficacies in the treatment of degenerative lumbar diseases. However, visualized endoscopic foraminoplasty has shorter operative time and fewer C-arm fluoroscopies compared to traditional endoscopic foraminoplasty.