摘要
目的全面分析腰椎间盘突出后的重吸收发生率,为其临床决策提供参考数据。方法在PubMed、Embase、the Cochrane Central Register of Controlled Trials、Web of Science、中国知网、万方和维普7个数据库中检索从建库至2020年3月所有可能在非手术治疗后的随访过程中报道突出椎间盘形态变化的文献。按纳入排除标准筛选文献,从纳入文献提取患者总数、发生重吸收患者数,以及其他重要数据进行分析。使用随机效应模型进行meta分析,并进行亚组分析、敏感性分析、meta回归分析和发表偏倚检测。结果通过数据库共检索到15712篇文献,48篇纳入分析。共纳入2880例非手术治疗的腰椎间盘突出症患者,其中1740例出现了重吸收。Meta分析显示重吸收发生率为0.60[95%置信区间(confidence interval,CI)(0.46,0.72)]。亚组分析显示,采用定量测量的重吸收发生率[0.73,95%CI(0.60,0.85)]高于定性测量的重吸收发生率[0.51,95%CI(0.34,0.69)],差异有统计学意义(P=0.0252);合并后的重吸收发生率按随机对照试验[0.50,95%CI(0.15,0.85)]、非随机对照试验的所有前瞻性研究[0.59,95%CI(0.48,0.70)]、回顾性研究[0.69,95%CI(0.36,0.95)]递增,但差异无统计学意义(P=0.7523)。逐个剔除纳入研究后分别进行meta分析显示重吸收率在0.58[95%CI(0.54,0.71)]和0.62[95%CI(0.49,0.74)]之间。只纳入低风险随机对照试验和高质量非随机对照研究的meta分析得出的重吸收发生率与原始meta分析结果比较没有明显变化[0.62,95%CI(0.43,0.79)]。Meta回归发现测量方法是部分异质性来源(R~2=15.34%,P=0.0858)。Egger检验未发现明显的发表偏倚(P=0.4622)。结论根据现有研究,腰椎间盘突出后重吸收的总发生率为60%[95%CI(46%,72%)],在决定手术治疗之前应充分考虑重吸收的可能性。
Objective To comprehensively investigate the incidence of resorption of lumbar disc herniation,and provide reference data for clinical decision-making.Methods Seven electronic databases(PubMed,Embase,the Cochrane Central Register of Controlled Trials,Web of Science,China National Knowledge Infrastructure,Wangfang data and Chongqing VIP database)were searched for relevant studies that might have reported morphologic changes in lumbar disc herniation when reporting the follow-up results of patients with lumbar disc herniation treated nonsurgically from inception to March,2020.Articles were screened according to inclusion and exclusion criteria,and the total number of patients,number of patients with resorption,and other important data were extracted for analysis.Random effect models were used for meta-analysis,and subgroup analysis,sensitivity analysis,meta-regression analysis,and Egger’s test were performed.Results A total of 15712 articles were identified from these databases,and 48were eligible for analysis.A total of 2880 non-surgically treated patients with lumbar disc herniation were included in the meta-analysis,1740 of whom presented resorption.Meta-analysis revealed that the incidence of resorption was 0.60[95%confidence interval(CI)(0.46,0.72)].In subgroup analyses,studies that quantitatively measured the resorption of lumbar disc herniation yielded statistically higher pooled incidence[0.73,95%CI(0.60,0.85)]than those that used qualitative methods[0.51,95%CI(0.34,0.69)](P=0.0252).The pooled incidence gradually increased in randomized controlled trials(RCTs)[0.50,95%CI(0.15,0.85)],non-RCT prospective studies[0.59,95%CI(0.48,0.70)]and retrospective studies[0.69,95%CI(0.36,0.95)],but the difference was not statistically significant(P=0.7523).The pooled incidence varied from 0.58[95%CI(0.54,0.71)]to 0.62[95%CI(0.49,0.74)]after the sequential omission of each single study.There was no significant change in the pooled incidence[0.62,95%CI(0.43,0.79)]when only low-risk RCTs and high-quality non-RCT studies were included,comparing with original meta-analysis results.Meta-regression showed that measurements partially caused heterogeneity(R~2=15.34%,P=0.0858).Egger’s test suggested that there was no publication bias(P=0.4622).Conclusions According to current research,there is an overall incidence of resorption of 60%[95%CI(46%,72%)]among non-surgically treated patients with lumbar disc herniation.The probability of resorption should be fully considered before making a decision on surgery.
作者
王一
姜玲
戴国钢
李冷陶
王澜洁
WANG Yi;JIANG Ling;DAI Guogang;LI Lengtao;WANG Lanjiel(Cervicodynia/Omalgia/Lumbago/Sciatica Department 2,Sichuan Provincial Orthopedic Hospital,Chengdu,Sichuan 610041,P.R.China;College Hospital,Sichuan Agricultural University-Chengdu Campus,Chengdu,Sichuan 611130,P.R.China;School of Sports Medicine and Health,Chengdu Sport University,Chengdu,Sichuan 610041,P.R.China)
出处
《华西医学》
CAS
2022年第8期1221-1230,共10页
West China Medical Journal
基金
四川省中医药管理局科研课题(2020JC0103)。
