PETD与PEID治疗单节段LDH疗效比较的Meta分析

A Meta-Analysis Comparing the Efficacy of PETD and PEID in the Treatment of Single-Level Lumbar Disc Herniation

摘要: 目的：系统分析PETD与PEID治疗单节段LDH的相关的术中情况及术后疗效。方法：对Pub-Med、Med of science、中国期刊全文数据库(CNKI)、维普数据库、万方数据库进行关于PELD相关文献进行检索，语种为英文或中文。由两位作者独立对各研究进行评估，并将各数据导入Revman 5.3软件进行Meta分析，来评估两种入路技术在各种结局指标的统计学意义。结果：最终共计15篇研究被纳入，共计1422例患者被纳入分析。PETD与PEID比较：后者手术时间更短(MD = 6.11, 95% CI: −1.86~14.07)，而差异不存在统计学意义(P > 0.05)；PEID术中X光线透视次数更少(MD = 9.05, 95% CI: 7.17~10.92, P < 0.00001)；两组比较术中出血量(MD = 0.70, 95% CI: −0.29~1.07)、术后卧床时间(MD = 1.48, 95% CI: −0.49~3.44)、住院时间(MD = 0.51, 95% CI: −0.60~1.63)、术后复发率(OR = 1.17, 95% CI：0.59~2.34)、术后12月末次随访优良率(OR = 0.89, 95% CI: 0.61~1.31)差异较小，均无统计学意义(P > 0.05)；两组的术后1天腰痛VAS变化值(MD = −0.04, 95% CI: −0.34~0.27)，ODI变化值(MD = −0.64, 95% CI: −0.22~0.95)、术后1月腰痛VAS变化值(MD = −0.04, 95% CI: −0.34~0.27)和ODI变化值(MD = 0.21, 95% CI: −1.08~1.49)、术后3月腰痛VAS变化值(MD = −0.05, 95% CI: −0.24~0.14)和ODI变化值(MD = −0.88, 95% CI: −1.95~0.19)、术后6月腰痛VAS变化值(MD = 0.04, 95% CI: −0.20~0.29)和ODI变化值(MD = 0.61, 95% CI: −1.31~2.53)、术后12月腰痛VAS变化值(MD = 0.05, 95% CI: −0.09~0.19)和ODI变化值(MD = −0.20, 95% CI: −0.95~0.56)，均无统计学意义(P > 0.05)。结论：PETD和PEID治疗单节段LDH均具有良好的临床疗效，但PEID术中X光线透视次数更少，且手术时间可能更短。PETD更具微创性，能够更少破坏脊柱骨性结构，短期内更好地缓解腰腿痛。

Abstract: Objective: To systematically analyze the intraoperative and postoperative effects of two approaches of percutaneous spinal endoscopy in the treatment of lumbar disc herniation. Methods: Clinical studies related to PELD were searched in English or Chinese by Pub-Med, Med of Science, China Journal Full-text Database (CNKI), VIP database and Wanfang database. Two authors independently assessed the quality of each study, and a meta-analysis of each data was performed using Revman 5.3 software to evaluate the statistical significance of the two approach techniques in various outcome indicators. Results: A total of 15 studies were eventually included, with a total of 1422 patients included in the analysis. Comparison between PETD and PEID: the operation time of the latter group was shorter than that of the former group (MD = 6.11, 95% CI: −1.86~14.07), but the difference was not statistically significant (P > 0.05). The latter had fewer intraoperative fluoroscopy times than the former (MD = 9.05, 95% CI: 7.17~10.92, P < 0.00001). Intraoperative blood loss (MD = 0.70, 95% CI: −0.29~1.07), postoperative bed rest time (MD = 1.48, 95% CI: −0.49~3.44), length of hospital stay(MD = 0.51, 95% CI: −0.60~1.63), the postoperative recurrence rate (OR = 1.17, 95% CI: 0.59~2.34) and the rate of excellent and good follow-up at the end of 12 months after surgery (OR = 0.89, 95% CI: 0.61~1.31) had little difference, with no statistical significance (P > 0.05). VAS change value of low back pain 1 day after surgery (MD = −0.04, 95% CI: −0.34~0.27), ODI change value (MD = −0.64, 95% CI: −0.22~0.95), VAS change value of low back pain 1 month after surgery (MD = −0.04, 95% CI: −0.34~0.27) and ODI (MD = 0.21, 95% CI: −1.08~1.49), VAS change value of low back pain 3 months after surgery (MD = −0.05, 95% CI: −0.24~0.14) and ODI change value (MD = −0.88, 95% CI: −1.95~0.19), the change of VAS for low back pain 6 months after surgery (MD = 0.04, 95% CI: −0.20~0.29) and ODI change value (MD = 0.61, 95% CI: −1.31~2.53), the change of VAS for low back pain 12 months after surgery (MD = 0.05, 95% CI: −0.09~0.19) and ODI change value (MD = −0.20, 95% CI: −0.95~0.56) were not statistically significant (P > 0.05). Conclusion: Both PETD and PEID have good clinical efficacy in the treatment of lumbar disc herniation, but PEID may have shorter operative time and fewer intraoperative X-ray times. PETD is more minimally invasive, can destroy less spinal bone structure, and can better relieve back and leg pain in the short term.