摘要
目的系统评价经皮椎间孔镜技术(PTED)治疗巨大型腰椎间盘突出症(GLDH)的疗效和安全性。方法检索Web of Science、PubMed、Cochrane Library、EBSCO、中国知网、维普、万方数据库中关于PTED治疗GLDH的临床疗效和安全性的单双多臂临床试验,检索时限为建库至2023年4月。由两名研究人员独立筛选文献、提取资料并评价纳入文献的质量,采用Stata 14.0软件对纳入文献的研究结果进行Meta分析。结果共纳入14篇文献,包括696例患者。Meta分析结果显示,与术前相比,术后1 d或3 d、术后3个月、末次随访时整体视觉模拟评分法(VAS)评分显著降低(MD=4.57,95%CI 3.89~5.24,P<0.00001;MD=6.36,95%CI 5.58~7.13,P<0.00001;MD=6.17,95%CI 5.31~7.04,P<0.00001),术后1 d或3 d、术后3个月、末次随访时腰痛VAS评分显著降低(MD=3.29,95%CI 1.24~5.34,P<0.00001;MD=3.12,95%CI 2.20~4.05,P<0.00001;MD=4.46,95%CI 3.74~5.17,P<0.00001),术后末次随访时下肢痛VAS评分显著降低(MD=5.92,95%CI 5.55~6.30,P<0.00001),术后1 d或3 d、术后3个月、末次随访时Oswestry功能障碍指数评分显著降低(MD=23.79,95%CI 8.77~38.82,P=0.002;MD=36.00,95%CI 26.56~45.44,P<0.00001;MD=37.11,95%CI 31.26~42.95,P<0.00001),术后末次随访时日本骨科协会评分显著增加(MD=-14.37,95%CI-17.62~-11.13,P<0.00001),术后3个月直腿抬高角度显著增加(MD=-39.29,95%CI-43.25~-35.33,P<0.00001)。术中硬膜囊完整率为99.4%(621/625),术中神经根未受压迫率为99.7%(623/625)。结论PTED治疗能显著缓解GLDH患者腰部和下肢疼痛,显著提高人体功能性指数,术后末次随访优良率高,术中取髓核时安全性高,疗效显著。
Objective To evaluate the efficacy and safety of percutaneous transforaminal endoscopic discectomy(PTED)in the treatment of giant lumbar disc herniation(GLDH).Methods The single,double,and multi-arm clinical trials on the clinical efficacy and safety of PTED for GLDH were searched from Web of Science,PubMed,Cochrane Library,EBSCO,CNKI,VIP,and Wanfang database from the inception to Apr.2023.Two researchers independently screened the literature,extracted the data,and evaluated the quality of the included literature.Stata 14.0 software was used to conduct a meta-analysis of the results of the included literature.Results A total of 14 trials were included,including 696 patients.The results of meta-analysis showed that the overall visual analogue scale(VAS)scores decreased at 1 d or 3 d,3 months after surgery and last follow-up(MD=4.57,95%CI 3.89-5.24,P<0.00001;MD=6.36,95%CI 5.58-7.13,P<0.00001;MD=6.17,95%CI 5.31-7.04,P<0.00001),the lumbar VAS scores decreased at 1 d or 3 d,3 months after surgery and last follow-up(MD=3.29,95%CI 1.24-5.34,P<0.00001;MD=3.12,95%CI 2.20-4.05,P<0.00001;MD=4.46,95%CI 3.74-5.17,P<0.00001),the VAS score of lower extremity decreased at the last postoperative follow-up(MD=5.92,95%CI 5.55-6.30,P<0.00001),the Oswestry disability index scores decreased at 1 d or 3 d,3 months after surgery and last follow-up(MD=23.79,95%CI 8.77-38.82,P=0.002;MD=36.00,95%CI 26.56-45.44,P<0.00001;MD=37.11,95%CI 31.26-42.95,P<0.00001),the postoperative Japanese Orthopedic Association score increased at the last postoperative follow-up(MD=-14.37,95%CI-17.62--11.13,P<0.00001),and the angle of straight leg elevation increased three months after surgery(MD=-39.29,95%CI-43.25--35.33,P<0.00001),compared with the preoperative period.The intraoperative dural sac integrity rate was 99.4%(621/625),and the intraoperative nerve root uncompression rate was 99.7%(623/625).Conclusion PTED treatment can significantly relieve waist and lower limb pain in GLDH patients,significantly improve the body functional index,and has high excellent rate of last postoperative follow-up,high safety of intraoperative nucleus pulposus,significant efficacy.
作者
胡辉林
黎永生
葛北海
HU Huilin;LI Yongsheng;GE Beihai(Department of Bone Surgery,Guangxi Zhuang Autonomous Region Brain Hospital,Liuzhou 545005,China;Department of Neurology,Guangxi Zhuang Autonomous Region Brain Hospital,Liuzhou 545005,China)
出处
《医学综述》
CAS
2024年第13期1643-1651,共9页
Medical Recapitulate
基金
广西壮族自治区卫生和计划生育委员会自筹经费科研课题项目(Z20170199)
广西自然科学基金面上项目(2020GXNSFAA297115)。
关键词
巨大型腰椎间盘突出症
经皮椎间孔镜技术
META分析
Giant lumbar disc herniation
Percutaneous transforaminal endoscopic discectomy
Meta-analysis
