Lu Honghui, Yao Yu, Shi Ligang
Department of Orthopaedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, 5 Haiyuncang, Dongcheng District, Beijing, 100700 China.
Department of Orthopaedics, Hospital of Chinese Armed Police Beijing Corps, Beijing, China.
Indian J Orthop. 2022 Apr 22;56(6):983-995. doi: 10.1007/s43465-022-00636-1. eCollection 2022 Jun.
This meta-analysis evaluated surgical outcomes following endoscopic or conventional discectomy for recurrent lumbar disc herniation.
Medline, Cochrane, EMBASE, and Google Scholar were search until October 16, 2016 using these terms: recurrent lumbar disc herniation, endoscopic surgery, and discectomy. Randomized controlled trials (RCTs), prospective, retrospective, and cohort studies were eligible for inclusion. Pooled difference in mean (PDM) with 95% confidence interval (CIs) or relative risks (RRs) were calculated using fixed-effects methods.
One RCT and 15 studies were included with a total of 820 patients. Patients received endoscopic surgery experienced shorter operation time than those received conventional surgery (PDM: -52.01, 95% CI: -76.84 to -27.18, < 0.001). A significantly lower risk in complication was displayed in patients received endoscopic surgery compared to those received conventional surgery (RR: 0.209, 95% CI: 0.076-0.581, = 0.003). No significant difference in the improvement in VAS (PDM: -2.19, 95% CI: -5.78 to 1.39, = 0.231), length of stay (PDM: -6.44, 95% CI: -13.76 to 0.89, = 0.085) and re-recurrence rate (PDM: 0.88, 95% CI: 0.22-3.50, = 0.861) between groups.
Endoscopic and conventional discectomy reduced patient pain comparably, but endoscopic discectomy had significantly lower operation time and lower risk in complications, which may impact other outcomes such as recovery and healthcare costs. More studies are needed to confirm our findings.
The online version contains supplementary material available at 10.1007/s43465-022-00636-1.
本荟萃分析评估了复发性腰椎间盘突出症患者接受内镜下椎间盘切除术或传统椎间盘切除术后的手术效果。
截至2016年10月16日，使用“复发性腰椎间盘突出症”“内镜手术”和“椎间盘切除术”等术语检索了Medline、Cochrane、EMBASE和谷歌学术。随机对照试验（RCT）、前瞻性、回顾性和队列研究均符合纳入标准。采用固定效应方法计算平均差异合并值（PDM）及95%置信区间（CI）或相对风险（RR）。
纳入1项RCT和15项研究，共820例患者。接受内镜手术的患者手术时间比接受传统手术的患者短（PDM：-52.01，95%CI：-76.84至-27.18，P<0.001）。与接受传统手术的患者相比，接受内镜手术的患者并发症风险显著降低（RR：0.209，95%CI：0.076-0.581，P=0.003）。两组在视觉模拟评分法（VAS）改善情况（PDM：-2.19，95%CI：-5.78至1.39，P=0.231）、住院时间（PDM：-6.44，95%CI：-13.76至0.89，P=0.085）和再复发率（PDM：0.88，95%CI：0.22-3.50，P=0.861）方面无显著差异。
内镜下椎间盘切除术和传统椎间盘切除术减轻患者疼痛的效果相当，但内镜下椎间盘切除术的手术时间显著更短，并发症风险更低，这可能会影响恢复和医疗费用等其他结果。需要更多研究来证实我们的发现。
在线版本包含可在10.1007/s43465-022-00636-1获取的补充材料。
