有症状的腰椎间盘突出症不同椎间盘切除术技术的并发症发生率：一项系统评价和荟萃分析。
Complication rates of different discectomy techniques for symptomatic lumbar disc herniation: a systematic review and meta-analysis.
作者信息
Chen Xiaolong, Chamoli Uphar, Vargas Castillo Jose, Ramakrishna Vivek A S, Diwan Ashish D
机构信息
Spine Labs, Level 3, WR Pitney Building, St. George and Sutherland Clinical School, University of New South Wales, Kogarah, NSW, 2217, Australia.
School of Biomedical Engineering, Faculty of Engineering and Information Technology, University of Technology Sydney, Ultimo, NSW, Australia.
出版信息
Eur Spine J. 2020 Jul;29(7):1752-1770. doi: 10.1007/s00586-020-06389-5. Epub 2020 Apr 9.
PURPOSE
This meta-analysis aims to compare the complication rates of discectomy/microdiscectomy (OD/MD), microendoscopic discectomy (MED), percutaneous endoscopic lumbar discectomy (PELD), percutaneous laser disc decompression (PLDD), and tubular discectomy for symptomatic lumbar disc herniation (LDH) using general classification and modified Clavien-Dindo classification (MCDC) schemes.
METHODS
We searched three online databases for randomized controlled trials (RCTs) and cohort studies. Overall complication rates and complication rates per the above-mentioned classification schemes were considered as primary outcomes. Risk ratio (RR) and their 95% confidence intervals (CI) were evaluated.
RESULTS
Seventeen RCTs and 20 cohort studies met the eligibility criteria. RCTs reporting OD/MD, MED, PELD, PLDD, and tubular discectomies had overall complication rates of 16.8% and 16.1%, 21.2%, 5.8%, 8.4%, and 25.8%, respectively. Compared with the OD/MD, there was moderate-quality evidence suggesting that PELD had a lower risk of overall complications (RR = 0.52, 95% CI 0.29-0.91) and high-quality evidence suggesting a lower risk of Type I complications per MCDC (RR = 0.37, 95% CI 0.16-0.81). Compared with the OD/MD data from cohort studies, there was low-quality evidence suggesting a higher risk of Type III complications per MCDC (RR = 10.83, 95% CI 1.29-91.18) for MED, higher risk of reherniations (RR = 1.67,95% CI 1.05-2.64) and reoperations (RR = 1.75, 95% CI 1.20-2.55) for PELD, lower risk of overall complication rates (RR = 0.42, 95% CI 0.25-0.70), post-operative complication rates (RR = 0.42, 95% CI 0.25-0.70), Type III complications per MCDC (RR = 0.39, 95% CI 0.22-0.69), reherniations (RR = 0.56, 95% CI 0.33-0.97) and reoperations (RR = 0.39, 95% CI 0.22-0.69) for PLDD.
CONCLUSIONS
Compared with the OD/MD, results of this meta-analysis suggest that PELD has a lower risk of overall complications and a lower risk of complications necessitating conservative treatment. These slides can be retrieved under Electronic Supplementary Material.
目的
本荟萃分析旨在使用通用分类和改良的Clavien-Dindo分类（MCDC）方案，比较椎间盘切除术/显微椎间盘切除术（OD/MD）、显微内镜下椎间盘切除术（MED）、经皮内镜下腰椎间盘切除术（PELD）、经皮激光椎间盘减压术（PLDD）和管状椎间盘切除术治疗症状性腰椎间盘突出症（LDH）的并发症发生率。
方法
我们在三个在线数据库中检索随机对照试验（RCT）和队列研究。将总体并发症发生率以及上述分类方案下的并发症发生率作为主要结局指标。评估风险比（RR）及其95%置信区间（CI）。
结果
17项RCT和20项队列研究符合纳入标准。报告OD/MD、MED、PELD、PLDD和管状椎间盘切除术的RCT的总体并发症发生率分别为16.8%、16.1%、21.2%、5.8%、8.4%和25.8%。与OD/MD相比，有中等质量证据表明PELD总体并发症风险较低（RR = 0.52，95% CI 0.29 - 0.91），且有高质量证据表明按照MCDC标准I型并发症风险较低（RR = 0.37，95% CI 0.16 - 0.81）。与队列研究中的OD/MD数据相比，有低质量证据表明MED按照MCDC标准III型并发症风险较高（RR = 10.83，95% CI 1.29 - 91.18），PELD再突出风险较高（RR = 1.67，95% CI 1.05 - 2.64）和再次手术风险较高（RR = 1.75，95% CI 1.20 - 2.55），PLDD总体并发症发生率较低（RR = 0.42，95% CI 0.25 - 0.70）、术后并发症发生率较低（RR = 0.42，95% CI 0.25 - 0.70）、按照MCDC标准III型并发症风险较低（RR = 0.39，95% CI 0.22 - 0.69）、再突出风险较低（RR = 0.56，95% CI 0.33 - 0.97）和再次手术风险较低（RR = 0.39，95% CI 0.22 - 0.69）。
结论
与OD/MD相比，本荟萃分析结果表明PELD总体并发症风险较低，且需要保守治疗的并发症风险较低。这些幻灯片可在电子补充材料中获取。
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