Wei Fei-Long, Li Tian, Gao Quan-You, Yang Yi, Gao Hao-Ran, Qian Ji-Xian, Zhou Cheng-Pei
Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China.
School of Basic Medicine, Fourth Military Medical University, Xi'an, China.
Front Surg. 2021 Jul 20;8:679142. doi: 10.3389/fsurg.2021.679142. eCollection 2021.
Therapeutic options for lumbar disc surgery (LDH) have been rapidly evolved worldwide. Conventional pair meta-analysis has shown inconsistent results of the safety of different surgical interventions for LDH. A network pooling evaluation of randomized controlled trials (RCT) was conducted to compare eight surgical interventions on complications for patients with LDH. PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for RCT from inception to June 2020, with registration in PROSPERO (CRD42020176821). This study is conducted in accordance with Cochrane guidelines. Primary outcomes include intraoperative, post-operative, and overall complications, reoperation, operation time, and blood loss. A total of 27 RCT with 2,948 participants and eight interventions, including automated percutaneous lumbar discectomy (APLD), chemonucleolysis (CN), microdiscectomy (MD), micro-endoscopic discectomy (MED), open discectomy (OD), percutaneous endoscopic lumbar discectomy (PELD), percutaneous laser disc decompression (PLDD), and tubular discectomy (TD) were enrolled. The pooling results suggested that PELD and PLDD are with lower intraoperative and post-operative complication rates, respectively. TD, PELD, PLDD, and MED were the safest procedures for LDH according to complications, reoperation, operation time, and blood loss. The results of this study provided evidence that PELD and PLDD were with lower intraoperative and post-operative complication rates, respectively. TD, PELD, PLDD, and MED were the safest procedures for LDH according to complications, reoperation, operation time, and blood loss. PROSPERO, identifier CRD42020176821.
腰椎间盘手术(LDH)的治疗选择在全球范围内迅速发展。传统的配对荟萃分析显示,针对LDH的不同手术干预措施的安全性结果并不一致。进行了一项随机对照试验(RCT)的网状汇总评估,以比较八种手术干预措施对LDH患者并发症的影响。检索了PubMed、Embase和Cochrane对照试验中央注册库(CENTRAL),以获取从创刊到2020年6月的RCT,并在PROSPERO(CRD42020176821)中进行了注册。本研究按照Cochrane指南进行。主要结局包括术中、术后和总体并发症、再次手术、手术时间和失血量。总共纳入了27项RCT,涉及2948名参与者和八种干预措施,包括自动经皮腰椎间盘切除术(APLD)、化学髓核溶解术(CN)、显微椎间盘切除术(MD)、显微内镜椎间盘切除术(MED)、开放式椎间盘切除术(OD)、经皮内镜腰椎间盘切除术(PELD)、经皮激光椎间盘减压术(PLDD)和管状椎间盘切除术(TD)。汇总结果表明,PELD和PLDD分别具有较低的术中和术后并发症发生率。根据并发症、再次手术、手术时间和失血量,TD、PELD、PLDD和MED是LDH最安全的手术方法。本研究结果提供了证据,表明PELD和PLDD分别具有较低的术中和术后并发症发生率。根据并发症、再次手术、手术时间和失血量,TD、PELD、PLDD和MED是LDH最安全的手术方法。PROSPERO标识符:CRD42020176821。
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