单侧双通道脊柱内镜与单通道内镜下手术治疗腰椎管狭窄症临床疗效的Meta分析

Meta-Analysis of the Clinical Efficacy of Unilateral Biportal Endoscopic and Uniportal Endoscopic Surgery in the Treatment of Lumbar Spinal Stenosis

摘要: 目的：通过比较单侧双通道内镜手术(unilateral biportal endoscopy, UBE)与单通道内镜手术(uniportal endoscopy, UE)治疗腰椎管狭窄症(lumbar spinal stenosis, LSS)的疗效进行荟萃分析研究。方法：在英文数据库PubMed、Web of science、Embase、Cochrane Library，以及中文数据库中国知网、中国生物医学文献数据库、维普(VIP)及万方数据库检索从建库至2025年12月发表的关于UBE与UE手术疗效对比的临床研究，通过筛选文献后进一步提取数据，采用RevMan 5.3软件进行荟萃分析。评价指标包括：术后腰腿痛视觉模拟评分(visual analogue scale, VAS)、Oswestry功能障碍指数(Oswestry disability index, ODI)、日本骨科协会评估治疗分数(Japanese Orthopaedic Association scores, JOA)、改良MacNab标准评定、并发症发生率、手术时间、术中出血量、切口总长度、术后活动时间和术后住院时间。结果：最终纳入26篇文献，共纳入2326名患者，其中UBE组纳入1201例患者，UE组纳入1125例患者。Meta分析结果表明：UBE技术与UE技术相比，UBE组在术后3个月内VAS评分[WMD = −0.14, 95%CI (−0.25, −0.02), P = 0.02]、3至6个月VAS评分[WMD = −0.77, 95%CI (−1.31, −0.23), P = 0.005]、术后3至6个月ODI评分[WMD = −2.39, 95%CI (−4.11, −0.67), P = 0.006]、JOA评分[WMD = 2.29, 95%CI (0.72, 3.86), P = 0.004]、改良MacNab标准[OR = 1.75, 95%CI (1.30, 2.36), P = 0.0002]、并发症发生率[OR = 0.39, 95%CI (0.27, 0.56), P < 0.00001]、手术时间[WMD = −1.15, 95%CI (−1.78, −0.52), P = 0.0004]、切口总长度[WMD = 0.62, 95%CI (0.54, 0.70), P < 0.00001]方面差异具有统计学意义；在术中出血量、术后活动时间、术后住院时间、术后6至12个月VAS评分、术后3个月及术后大于6个月ODI评分上两组对比无显著差异。结论：本研究结果表明，UBE技术对于治疗LSS在减轻术后早期疼痛、改善JOA评分、减少手术并发症、缩短手术时间上优于UE技术，说明UBE技术是一种治疗腰椎管狭窄症疗效满意的脊柱微创技术。

Abstract: Objectives: To compare the therapeutic effects of unilateral biportal endoscopic surgery (UBE) and unipolar endoscopic surgery (UE) in the treatment of lumbar spinal stenosis (LSS) with Meta-analysis. Methods: Clinical studies comparing the therapeutic effects of UBE and UE published from the establishment of the databases to December 2025 were retrieved from the English databases PubMed, Web of Science, Embase, and Cochrane Library, as well as the Chinese databases CNKI, CBM, VIP, and Wanfang. After screening the literature, data were further extracted and a Meta-analysis was conducted using RevMan 5.3 software. The evaluation indicators included: postoperative visual analogue scale (VAS) for low back and leg pain, Oswestry disability index (ODI), Japanese Orthopaedic Association scores (JOA), modified MacNab standard assessment, incidence of complications, operation time, intraoperative blood loss, total incision length, postoperative activity time, and postoperative hospital stay. Results: A total of 26 articles were ultimately included, involving 2326 patients in total. Among them, 1201 patients were included in the UBE group, and 1125 patients were included in the UE group. The results of the Meta-analysis indicated that compared with the UE technique, the UBE group showed statistically significant differences in the following aspects: VAS score within 3 months after surgery [WMD = −0.14, 95%CI (−0.25, −0.02), P = 0.02], VAS score from 3 to 6 months after surgery [WMD = −0.77, 95%CI (−1.31, −0.23), P = 0.005], ODI score from 3 to 6 months after surgery [WMD = −2.39, 95%CI (−4.11, −0.67), P = 0.006], JOA score [WMD = 2.29,95%CI (0.72,3.86), P = 0.004], modified MacNab criteria [OR = 1.75, 95%CI (1.30, 2.36), P = 0.0002], complication incidence [OR = 0.39,95% CI (0.27, 0.56), P < 0.00001], operation time [WMD = −1.15,95%CI (−1.78, −0.52), P = 0.0004], and total incision length [WMD = 0.62,95%CI (0.54, 0.70), P < 0.00001]. There were no significant differences between the two groups in terms of intraoperative blood loss, postoperative activity time, postoperative hospital stay, VAS score from 6 to 12 months after surgery, and ODI score at 3 months after surgery and more than 6 months after surgery. Conclusion: The results of this study indicate that the UBE technique is superior to the UE technique in treating LSS, as it is more effective in reducing early postoperative pain, improving the JOA score, minimizing surgical complications and shortening the operation time. This suggests that the UBE technique is a satisfactory minimally invasive spinal treatment method for lumbar spinal stenosis.