Department of Orthopaedics, PGIMER, Chandigarh, India.
Queens Medical Center, Nottingham, UK.
Arch Orthop Trauma Surg. 2023 Sep;143(9):5589-5601. doi: 10.1007/s00402-023-04870-6. Epub 2023 Apr 12.
Lumbar disc herniation in obese individuals poses unique surgical challenges which can influence outcomes in such patients. Limited studies are available evaluating the results of discectomy in obese persons. The aim of this review was to compare outcomes in obese and non-obese individuals; and to analyse whether approach to surgery had a bearing on these outcomes.
The literature search was conducted on four databases (PubMed, Medline, EMBASE, and CINAHL) and PRISMA guidelines were followed. After screening by the authors, eight studies were shortlisted from which data were extracted and analysed. Comparative analysis was done for lumbar discectomy (microdiscectomy or minimally invasive vs. endoscopic technique) between obese and non-obese groups from the six comparative studies in our review. Pooled estimates and subgroup analysis was done to ascertain the effect of surgical approach on outcomes.
Eight studies published between 2007 and 2021 were included. Mean age of study cohort was 39.05 years. Mean operative time was significantly shorter in the non-obese group mean difference of 15.1 min (95% CI - 0.24 to 30.5). On subgroup analysis, obese individuals operated via endoscopic approach had significantly decreased operative time as compared to open approach. Blood loss and complication rates were also lower in the non-obese groups, but not statistically significant.
Significantly less mean operative time was seen in non-obese individuals and when obese patients were operated via endoscopic approach. This difference between obese and non-obese groups was significantly more in the open subgroup as compared to the endoscopic subgroup. No significant differences in blood loss, mean improvement in VAS score, recurrence rate, complication rate and length of hospital stay was found between obese and non-obese patients as well as between endoscopic versus open lumbar discectomy within the obese subgroup. The learning curve associated with endoscopy makes it a challenging procedure.
肥胖个体的腰椎间盘突出症带来了独特的手术挑战，这可能会影响此类患者的治疗效果。目前评估肥胖患者椎间盘切除术效果的研究有限。本研究旨在比较肥胖和非肥胖患者的治疗效果，并分析手术入路是否对这些结果有影响。
我们在四个数据库（PubMed、Medline、EMBASE 和 CINAHL）中进行了文献检索，并遵循 PRISMA 指南。经过作者筛选，从 8 项研究中确定了 8 项研究，从中提取和分析了数据。从我们综述中的 6 项比较研究中，对肥胖和非肥胖组之间的腰椎间盘切除术（显微镜下椎间盘切除术或微创手术与内窥镜技术）进行了比较分析。进行了荟萃分析和亚组分析，以确定手术方法对结果的影响。
纳入了 2007 年至 2021 年期间发表的 8 项研究。研究队列的平均年龄为 39.05 岁。非肥胖组的平均手术时间明显较短，平均差异为 15.1 分钟（95%CI -0.24 至 30.5）。亚组分析显示，与开放入路相比，经内窥镜入路的肥胖患者的手术时间明显缩短。非肥胖组的出血量和并发症发生率也较低，但无统计学意义。
非肥胖患者的平均手术时间明显较短，肥胖患者经内窥镜入路手术时也是如此。与内窥镜亚组相比，开放亚组肥胖组和非肥胖组之间的这种差异更为显著。肥胖患者和非肥胖患者之间，以及内窥镜与开放腰椎间盘切除术之间，在出血量、VAS 评分平均改善、复发率、并发症发生率和住院时间方面均无显著差异。内窥镜相关的学习曲线使其成为一项具有挑战性的手术。
