Department of Orthopedic Surgery, Gangnam Nanoori Hospital, 731 Eonju-ro, Gangnam-gu, Seoul 06048, Republic of Korea.
Department of Health Policy and Management, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea.
Biomed Res Int. 2018 Aug 7;2018:9073460. doi: 10.1155/2018/9073460. eCollection 2018.
Among the surgical methods for lumbar disc herniation, open lumbar microdiscectomy is considered the gold standard. Recently, percutaneous endoscopic lumbar discectomy is also commonly performed for lumbar disc herniation for its various strong points.
The present study aims to examine whether percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy show better results as surgical treatments for lumbar disc herniation in the Korean population.
In the present meta-analysis, papers on Korean patients who underwent open lumbar microdiscectomy and percutaneous endoscopic lumbar discectomy were searched, both of which are surgical methods to treat lumbar disc herniation. The papers from 1973, when percutaneous endoscopic lumbar discectomy was first introduced, to March 2018 were searched at the databases of MEDLINE, EMBASE, PubMed, and Cochrane Library.
Seven papers with 1254 patients were selected. A comparison study revealed that percutaneous endoscopic lumbar discectomy had significantly better results than open lumbar microdiscectomy in the visual analogue pain scale at the final follow-up (leg: mean difference [MD]=-0.35; 95% confidence interval [CI]=-0.61, -0.09; p=0.009; back: MD=-0.79; 95% confidence interval [CI]=-1.42, -0.17; p=0.01), Oswestry Disability Index (MD=-2.12; 95% CI=-4.25, 0.01; p=0.05), operation time (MD=-23.06; 95% CI=-32.42, -13.70; p<0.00001), and hospital stay (MD=-4.64; 95% CI=-6.37, -2.90; p<0.00001). There were no statistical differences in the MacNab classification (odds ratio [OR]=1.02; 95% CI=0.71, 1.49; p=0.90), complication rate (OR=0.72; 95% CI=0.20, 2.62; p=0.62), recurrence rate (OR=0.83; 95% CI=0.50, 1.38; p=0.47), and reoperation rate (OR=1.45; 95% CI=0.89, 2.35; p=0.13).
All 7 papers used for the meta-analysis were non-RCTs. Some differences (type of surgery (primary or revisional), treatment options before the operation, follow-up period, etc.) existed depending on the selected paper, and the sample size was small as well.
While percutaneous endoscopic lumbar discectomy showed better results than open lumbar microdiscectomy in some items, open lumbar microdiscectomy still showed good clinical results, and it is therefore reckoned that a randomized controlled trial with a large sample size would be required in the future to compare these two surgical methods.
在腰椎间盘突出症的手术方法中，开放式腰椎显微切除术被认为是金标准。最近，经皮内窥镜腰椎间盘切除术也常用于治疗腰椎间盘突出症，因为它有很多优点。
本研究旨在探讨经皮内窥镜腰椎间盘切除术和开放式腰椎显微切除术作为治疗韩国人群腰椎间盘突出症的手术方法是否具有更好的效果。
在本次荟萃分析中，检索了 1973 年经皮内窥镜腰椎间盘切除术首次引入时至 2018 年 3 月期间接受开放式腰椎显微切除术和经皮内窥镜腰椎间盘切除术治疗腰椎间盘突出症的韩国患者的论文。检索数据库包括 MEDLINE、EMBASE、PubMed 和 Cochrane Library。
共选择了 7 篇论文，涉及 1254 名患者。一项对比研究表明，在末次随访时，经皮内窥镜腰椎间盘切除术在视觉模拟疼痛量表（腿：平均差值 [MD]=-0.35；95%置信区间 [CI]=-0.61，-0.09；p=0.009；背：MD=-0.79；95%置信区间 [CI]=-1.42，-0.17；p=0.01）、Oswestry 残疾指数（MD=-2.12；95% CI=-4.25，0.01；p=0.05）、手术时间（MD=-23.06；95% CI=-32.42，-13.70；p<0.00001）和住院时间（MD=-4.64；95% CI=-6.37，-2.90；p<0.00001）方面均优于开放式腰椎显微切除术。MacNab 分级（优势比 [OR]=1.02；95% CI=0.71，1.49；p=0.90）、并发症发生率（OR=0.72；95% CI=0.20，2.62；p=0.62）、复发率（OR=0.83；95% CI=0.50，1.38；p=0.47）和再手术率（OR=1.45；95% CI=0.89，2.35；p=0.13）方面无统计学差异。
荟萃分析中使用的 7 篇论文均为非随机对照试验。由于所选论文的不同（手术类型（初次手术或翻修手术）、手术前的治疗选择、随访时间等），存在一些差异，并且样本量较小。
虽然经皮内窥镜腰椎间盘切除术在某些项目上优于开放式腰椎显微切除术，但开放式腰椎显微切除术仍显示出良好的临床效果，因此需要未来进行一项具有较大样本量的随机对照试验来比较这两种手术方法。
