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微创 versus 开放颈椎侧块切除术:系统评价。

Minimally Invasive versus Open Cervical Foraminotomy: A Systematic Review.

机构信息

Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio.

MetroHealth Medical Center, Cleveland, Ohio.

出版信息

Global Spine J. 2011 Dec;1(1):9-14. doi: 10.1055/s-0031-1296050.

Abstract

Posterior cervical laminoforaminotomy is an effective treatment for cervical radiculopathy due to disc herniations or spondylosis. Over the last decade, minimally invasive (i.e., percutaneous) procedures have become increasingly popular due to a smaller incision size and presumed benefits in postoperative outcomes. We performed a systematic review of the literature and identified studies of open or percutaneous laminoforaminotomy that reported one or more perioperative outcomes. Of 162 publications found by our initial screening, 19 were included in the final analysis. Summative results indicate that patients undergoing percutaneous cervical laminoforaminotomy have lower blood loss by 120.7 mL (open: 173.5 mL, percutaneous: 52.8 mL, n = 670), a shorter surgical time by 50.0 minutes (open: 108.3 minutes, percutaneous: 58.3 minutes, n = 882), less inpatient analgesic use by 25.1 Eq (open: 27.6 Eq, percutaneous: 2.5 Eq, n = 356), and a shorter hospital stay by 2.2 days (open: 3.2 days, percutaneous: 1.0 days, n = 1472), compared with patients undergoing open procedures. However, the heterogeneous nature of published data calls into question the reliability of these summative results. Further structured trials should be conducted to better characterize the risks and benefits of percutaneous laminoforaminotomy.

摘要

颈椎后路椎板成形术和侧块切除术是治疗颈椎间盘突出症或颈椎病引起的神经根病的有效方法。在过去的十年中,由于切口较小和术后结果的预期改善,微创(即经皮)手术越来越受欢迎。我们对文献进行了系统回顾,确定了报道一种或多种围手术期结果的开放或经皮椎板成形术和侧块切除术的研究。通过我们最初的筛选,共发现 162 篇出版物,其中 19 篇被纳入最终分析。综合结果表明,接受经皮颈椎侧块切除术的患者失血量减少 120.7 毫升(开放手术:173.5 毫升,经皮手术:52.8 毫升,n=670),手术时间缩短 50.0 分钟(开放手术:108.3 分钟,经皮手术:58.3 分钟,n=882),住院期间镇痛药物使用量减少 25.1Eq(开放手术:27.6Eq,经皮手术:2.5Eq,n=356),住院时间缩短 2.2 天(开放手术:3.2 天,经皮手术:1.0 天,n=1472)。然而,发表数据的异质性使得这些综合结果的可靠性受到质疑。应进一步开展结构化试验,以更好地描述经皮椎板成形术和侧块切除术的风险和益处。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3da9/3864482/22e4d6d091f2/f00024-1.jpg

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