Zheng Bin, Yu Panfeng, Liang Yan, Zhu Zhenqi, Liu Haiying
Spine Surgery Department, Peking University People's Hospital, Beijing, China.
Front Surg. 2025 May 22;12:1572977. doi: 10.3389/fsurg.2025.1572977. eCollection 2025.
Percutaneous endoscopic lumbar discectomy (PELD) has become the preferred minimally invasive surgical treatment for lumbar disc herniation. This study aims to conduct a systematic literature review and meta-analysis to assess the efficacy and safety of ultrasound-guided PELD compared to x-ray-guided PELD.
A comprehensive literature search was conducted in the PubMed, Cochrane Library, Ovid:MEDLINE, Embase, and China National Knowledge Infrastructure databases up to August 2024. Studies were included if they compared ultrasound- and x-ray-guided PELD in patients with lumbar disc herniation. Risk of bias and quality of evidence were assessed using the Cochrane Collaboration tools and the Newcastle-Ottawa Scale. The meta-analysis was performed using RevMan 5.4.
Seven studies were included, for a total of 767 patients (383 who underwent ultrasound-guided PELD and 384 who underwent x-ray-guided PELD). Ultrasound guidance significantly reduced fluoroscopy shots, radiation dose, fluoroscopy time, and working channel establishment time compared to x-ray guidance. Ultrasound guidance also demonstrated higher one-time puncture success rates. No significant differences were found in overall operative time, complications, postoperative pain scores (visual analog scale), or long-term functional outcomes (oxygen desaturation index and satisfaction rates).
Ultrasound-guided PELD significantly reduces radiation exposure and improves puncture efficiency compared to x-ray-guided techniques while maintaining equivalent clinical outcomes and complication rates. However, due to study limitations, including small sample sizes and geographical concentration of research, further multicenter randomized controlled trials are necessary to validate these findings across diverse populations and surgical settings.
经皮内镜下腰椎间盘切除术（PELD）已成为腰椎间盘突出症首选的微创手术治疗方法。本研究旨在进行系统的文献综述和荟萃分析，以评估超声引导下的PELD与X线引导下的PELD相比的疗效和安全性。
截至2024年8月，在PubMed、Cochrane图书馆、Ovid:MEDLINE、Embase和中国知网数据库中进行了全面的文献检索。纳入比较超声引导和X线引导下的PELD治疗腰椎间盘突出症患者的研究。使用Cochrane协作工具和纽卡斯尔-渥太华量表评估偏倚风险和证据质量。使用RevMan 5.4进行荟萃分析。
纳入7项研究，共767例患者（383例行超声引导下的PELD，384例行X线引导下的PELD）。与X线引导相比，超声引导显著减少了透视次数、辐射剂量、透视时间和工作通道建立时间。超声引导还显示出更高的一次性穿刺成功率。在总手术时间、并发症、术后疼痛评分（视觉模拟量表）或长期功能结局（氧饱和度指数和满意率）方面未发现显著差异。
与X线引导技术相比，超声引导下的PELD显著减少了辐射暴露并提高了穿刺效率，同时保持了相当的临床结局和并发症发生率。然而，由于研究存在局限性，包括样本量小和研究的地理集中性，需要进一步开展多中心随机对照试验，以在不同人群和手术环境中验证这些发现。
