Ding Weilan, Yin Jianjian, Yan Ting, Nong Luming, Xu Nanwei
Department of Orthopedics, Changzhou Second People's Hospital, Nanjing Medical University, NO. 29 XingLongXiang, ZhongLou, 213003, Changzhou, China.
Orthopade. 2018 Jul;47(7):574-584. doi: 10.1007/s00132-018-3528-5.
The aim of this study was to systematically review the efficacy of percutaneous transforaminal endoscopic discectomy (PTED) and fenestration discectomy (FD) in the treatment of lumbar disc herniation (LDH).
We performed a systematic search in MEDLINE, EMBASE, PubMed, Web of Science, Cochrane databases, Chinese Biomedical Literature Database, CNKI, and Wanfang Data for all relevant studies. All statistical analyses wer performed using Review Manager version 5.3. Dichotomous data were calculated by odds ratio (OR) and continuous data were calculated by mean difference (MD) with 95% confidence intervals (CI).
A total of 17 articles with 1390 study subjects were included, with 733 patients in the PTED group and 657 patients in the FD group. The results of the meta-analysis showed that postoperative the visual analog scale (VAS) score (mean difference [MD] -0.13; 95% confidence interval [CI] -0.22 to -0.03; P = 0.009) and postoperative complications (MD 0.52; 95% CI 0.26 to 1.04; P = 0.06) showed no significant differences between the PTED group and the FD group, while the PTED group had significantly better results in operation time (MD 0.47; 95% CI -11.34 to 12.28; P = 0.94), length of incision (MD -3.74; 95% CI -4.28 to -3.19; P < 0.00001), amount of bleeding (MD -63.66, 95% CI -77.65 to -49.67; P < 0.00001), time of postoperative bed rest (MD -90.19; 95% CI -106.82 to -73.56; P < 0.00001), hospitalization time (MD -5.90; 95% CI -7.21 to -4.59; P < 0.00001), and postoperative Oswestry disability index (ODI) score (MD -0.59; 95% CI -1.11 to -0.08; P = 0.02) compared with the FD group.
The Percutaneous transforaminal endoscopic discectomy is associated with better postoperative ODI score, better results in length of incision, lower blood loss, shorter operation time, postoperative bed time and hospitalization time. The complications did not differ significantly between PTED and FD in the treatment of lumbar disc herniation. These findings provide evidence to support PTED is efficacious for LDH; however, scar repair of a ruptured anulus fibrosus needs a long time and the patients undergoing PTED should be advised to stay in bed for a long time even if the symptoms are markedly relieved. These results are not limited to randomized controlled trials and lack data about the long-term outcome.
本研究旨在系统评价经皮椎间孔镜下椎间盘切除术（PTED）与开窗髓核摘除术（FD）治疗腰椎间盘突出症（LDH）的疗效。
我们在MEDLINE、EMBASE、PubMed、Web of Science、Cochrane数据库、中国生物医学文献数据库、CNKI和万方数据中对所有相关研究进行了系统检索。所有统计分析均使用RevMan 5.3软件进行。二分类数据采用比值比（OR）计算，连续性数据采用均数差（MD）计算，并给出95%置信区间（CI）。
共纳入17篇文章，研究对象1390例，其中PTED组733例，FD组657例。Meta分析结果显示，PTED组与FD组术后视觉模拟评分（VAS）（均数差[MD] -0.13；95%置信区间[CI] -0.22至-0.03；P = 0.009）及术后并发症（MD 0.52；95% CI 0.26至1.04；P = 0.06）差异无统计学意义，但PTED组在手术时间（MD 0.47；95% CI -11.34至12.28；P = 0.94）、切口长度（MD -3.74；95% CI -4.28至-3.19；P < 0.00001）、出血量（MD -63.66，95% CI -77.65至-49.67；P < 0.00001）、术后卧床时间（MD -90.19；95% CI -106.82至-73.56；P < 0.00001）、住院时间（MD -5.90；95% CI -7.21至-4.59；P < 0.00001）及术后Oswestry功能障碍指数（ODI）评分（MD -0.59；95% CI -1.11至-0.08；P = 0.02）方面均显著优于FD组。
经皮椎间孔镜下椎间盘切除术术后ODI评分更好，切口长度更短，出血量更少，手术时间、术后卧床时间及住院时间更短。在治疗腰椎间盘突出症方面，PTED与FD的并发症差异无统计学意义。这些研究结果为支持PTED治疗LDH有效提供了证据；然而，纤维环破裂的瘢痕修复需要较长时间，即使症状明显缓解，接受PTED治疗的患者也应建议长时间卧床。这些结果并不局限于随机对照试验，且缺乏长期预后的数据。
