经皮椎间孔镜与椎板开窗术治疗腰椎间盘突出症的Meta分析

Meta Analysis of the Treatment of Lumbar Disc Herniation with Percutaneous Transforaminal Endoscopic Discectomy and Fenestration Discectomy

摘要: 目的：用Meta分析法系统评价经皮椎间孔镜腰椎间盘切除术(percutaneous transforaminal endoscopic discectomy, PTED)与椎板开窗髓核摘除术(fenestration discectomy, FD)治疗腰椎间盘突出症的临床效果。方法：计算机检索PubMed、Embase、Medline、Cochrane Library、中国期刊全文数据库、万方数据库、维普数据库等数据库建库到2016年，收集有关经皮椎间孔镜腰椎间盘切除术(PTED)与椎板开窗髓核摘除术(FD)治疗单节段腰椎间盘突出症的对照试验。将各项研究中的术后疗效(优良率)、手术时间、切口长度、术中出血量、术后卧床时间等相关数据采用ＲevMan5.3软件进行Meta分析。结果：本研究共纳入16篇临床对照研究，共计1362例单节段腰椎间盘突出症患者被纳入研究。Meta分析结果显示：PTED组与FD组相比，手术时间、切口长度、术中出血量、术后卧床时间方面差异有统计学意义(P < 0.05)，手术时间上PTED组长于FD组[MD = 16.16, 95% CI (5.23~27.08), (P = 0.004)]，切口长度PTED组较FD组短[MD = −3.46, 95% CI (−3.74~−3.19), (P < 0.00001)]，术中出血量PTED组较FD组少[MD = −61.92, 95% CI (−71.03~−52.81), (P < 0.00001)]，术后卧床时间PTED组较FD组短[MD = −63.39, 95% CI (−81.25~−45.53), (P < 0.00001)]，术后疗效(优良率)方面差异无统计学意义[OR = 94%, 95% CI (0.52~1.69), (P = 0.83)]。结论：PTED与FD在术后疗效方面无统计学差异，均可以有效治疗腰椎间盘突出症；PTED手术时间较FD手术时间长，但PTED相对于FD比较，PTED具有手术切口小、术中出血少、术后卧床时间短等优势。

Abstract: Objective: To evaluate the clinical effects of the treatment of lumbar disc herniation with percuta-neous transforaminal endoscopic discectomy (PTED) and fenestration discectomy (FD) with Me-ta-analysis. Methods: To collect controlled trials about the treatment of lumbar disc herniation with percutaneous transforaminal endoscopic discectomy (PTED) and fenestration discectomy (FD) by computer to search the related literatures from PubMed, Embase, Medline, Cochrane Library, CNKI database, Wan-fang database and Wei-pu database, since the databases were built up to 2016. All the data involving surgical outcomes, operative time, length of incision, peri-operative bleeding and bedridden time etc. are analyzed by the Meta-analysis with RevMan5.3. Results: This study involves 16 clinical controlled trials for total 1362 cases of one-level lumbar disc herniation. The Meta-analysis results show that compared with FD, the differences of operative time, length of incision, peri-operative bleeding and bedridden time are statistically significant in many aspects (P < 0.05); PTED operation time is longer than FD group [MD = 16.16, 95% CI (5.23~27.08), (P = 0.004)]; PTED length of incision is shorter than FD group [MD = −3.46, 95% CI (−3.74~−3.19), (P < 0.00001)]; PTED peri-operative bleeding is less than FD group [MD = −61.92, 95% CI (−71.03~−52.81), (P < 0.00001)]; PTED bedridden time is shorter than FD group [MD = −63.39, 95% CI (−81.25~−45.53), (P < 0.00001)]. The differences between the excellence and good rate of surgical outcomes of PTED and FD have no statistical significance [OR = 94%, 95% CI (0.52~1.69), (P = 0.83)]. Conclusion: Surgical outcomes of PTED and FD have no significant differences, and both are effective treatment for lumbar disc herniation. Compared with FD, although PTED operative time is longer than FD, PTED has advantages over FD in many aspects like length of incision, peri-operative bleeding and bedridden time.