Tang Yi, Zhang Zhongyi, Wu Zhouhan, Jin Zhaokai, Gong Yichen, Zhang Wen, Cheng Kai, Zhou Jiaju, Tong Peijian, Xu Taotao, Lv Shuaijie
Orthopedics and Traumatology Medical Center, The First Affiliated Hospital of Zhejiang Chinese Medical University (Orthopedics and Traumatology Hospital of Zhejiang Chinese Medical University), Hangzhou, Zhejiang, China.
Graduate School of Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China.
Int J Surg. 2025 Sep 1;111(9):6362-6373. doi: 10.1097/JS9.0000000000002686. Epub 2025 Jun 20.
This study aimed to evaluate the effect of early versus late postoperative ambulation on clinical outcomes and complications following unilateral biportal endoscopy (UBE) for lumbar disc herniation.
A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 guidelines. PubMed, Embase, Web of Science, and Cochrane Library were searched up to February 2025. Eligible studies were grouped based on ambulation timing: early (<24 hours) versus late (≥24 hours). Outcomes included changes in leg pain and back pain measured by the visual analog scale, functional recovery via the Oswestry Disability Index (ΔODI), complication rates, and patient satisfaction (MacNab criteria). A random-effects model was used to pool data and calculate weighted mean differences (WMDs) and 95% confidence intervals (CIs).
Fourteen retrospective studies comprising 715 patients were included (early group: 230; late group: 485). Early ambulation significantly improved leg pain within 3 days (WMD = -6.87; 95% CI: -7.48 to -6.26; P < 0.001) and at 6 months (WMD = -7.59; 95% CI: -7.98 to -7.20; P < 0.001), both exceeding the minimal clinically important difference. No significant between-group differences were observed for back pain (all time points), functional outcomes (ΔODI), complication rates, or patient satisfaction.
Early ambulation (<24 hours) after UBE is associated with superior short-term relief of leg pain and does not increase postoperative complication risk. However, it offers no advantage in long-term pain, disability, or satisfaction. Early mobilization can be safely recommended as part of postoperative care, with individualized protocols based on patient and surgical factors.
本研究旨在评估单侧双通道内镜（UBE）治疗腰椎间盘突出症术后早期与晚期活动对临床结局和并发症的影响。
按照PRISMA 2020指南进行系统评价和荟萃分析。检索截至2025年2月的PubMed、Embase、Web of Science和Cochrane图书馆。符合条件的研究根据活动时间分组：早期（<24小时）与晚期（≥24小时）。结局包括通过视觉模拟量表测量的腿痛和背痛变化、通过Oswestry功能障碍指数（ΔODI）评估的功能恢复、并发症发生率和患者满意度（MacNab标准）。采用随机效应模型汇总数据并计算加权平均差（WMD）和95%置信区间（CI）。
纳入14项回顾性研究，共715例患者（早期组：230例；晚期组：485例）。早期活动在术后3天（WMD = -6.87；95%CI：-7.48至-6.26；P < 0.001）和6个月时（WMD = -7.59；95%CI：-7.98至-7.20；P < 0.001）能显著改善腿痛，均超过最小临床重要差异。在背痛（所有时间点）、功能结局（ΔODI）、并发症发生率或患者满意度方面，两组间未观察到显著差异。
UBE术后早期（<24小时）活动与更好的短期腿痛缓解相关，且不会增加术后并发症风险。然而，在长期疼痛、功能障碍或满意度方面并无优势。早期活动可作为术后护理的一部分安全推荐，并根据患者和手术因素制定个性化方案。
