目的:本研究旨在比较单侧双孔内窥镜椎间盘切除术(UBED)与显微椎间盘切除术(MD)治疗腰椎间盘突出症(LDH)的疗效。
方法:在Embase进行了全面的文献检索,PubMed,科克伦图书馆,CNKI,和WebofScience数据库从数据库开始到2023年4月,以确定比较UBED和MD治疗LDH的研究。本研究评估了视觉模拟量表(VAS)评分,Oswestry残疾指数(ODI),Macnab得分,操作时间,估计失血量,住院,和并发症,估计失血量,视觉模拟量表(VAS)评分,Oswestry残疾指数(ODI),和Macnab评分在不同的术前和术后阶段。Meta分析采用RevMan5.4软件进行。
结果:荟萃分析包括9项不同的研究,共1001名患者。术后1-3个月(P=0.09)和最终随访(P=0.13)两组之间下腰痛的VAS评分没有显着差异;但是,UBED组术后1~3天的VAS评分较低(P=0.02).基线时腿部疼痛VAS评分差异无统计学意义(P=0.05)。术后1-3天(P=0.24),术后1~3个月(P=0.78),或最终随访时(P=0.43)。ODI比较显示术前无显著差异(P=0.83),术后1周(P=0.47),或术后1-3个月(P=0.13),UBED组在最终随访时表现出更好的ODI(P=0.03)。UBED组的平均手术时间也较短(P=0.03),显著缩短住院时间(P<0.00001),和较少的估计失血(P=0.0002)。并发症和改良的MacNab评分在两组之间没有显着差异(分别为P=0.56和P=0.05)。
结论:证据显示UBED和MD治疗LDH的疗效无显著差异。然而,UBED可能会提供潜在的好处,例如缩短住院时间,较低的估计失血量,和相当的并发症发生率。
OBJECTIVE: This study aimed to compare unilateral biportal endoscopic discectomy (UBED) with microdiscectomy (MD) for treating lumbar disk herniation (LDH).
METHODS: A comprehensive literature search was conducted in the Embase, PubMed, Cochrane Library, CNKI, and Web of Science databases from database inception to April 2023 to identify studies comparing UBED and MD for treating LDH. This study evaluated the visual analog scale (VAS) score, Oswestry disability index (ODI), Macnab scores, operation time, estimated blood loss, hospital stay, and complications, estimated blood loss, visual analog scale (VAS) score, Oswestry disability index (ODI), and Macnab scores at various pre- and post-surgery stages. The meta-analysis was performed using RevMan 5.4 software.
RESULTS: The meta-analysis included 9 distinct studies with a total of 1001 patients. The VAS scores for low back pain showed no significant differences between the groups at postoperative 1-3 months (P = 0.09) and final follow-up (P = 0.13); however, the UBED group had lower VAS scores at postoperative 1-3 days (P = 0.02). There were no significant differences in leg pain VAS scores at baseline (P = 0.05), postoperative 1-3 days (P = 0.24), postoperative 1-3 months (P = 0.78), or at the final follow-up (P = 0.43). ODI comparisons revealed no significant differences preoperatively (P = 0.83), at postoperative 1 week (P = 0.47), or postoperative 1-3 months (P = 0.13), and the UBED group demonstrated better ODI at the final follow-up (P = 0.03). The UBED group also exhibited a shorter mean operative time (P = 0.03), significantly shorter hospital stay (P < 0.00001), and less estimated blood loss (P = 0.0002). Complications and modified MacNab scores showed no significant differences between the groups (P = 0.56 and P = 0.05, respectively).
CONCLUSIONS: The evidence revealed no significant differences in efficacy between UBED and MD for LDH treatment. However, UBED may offer potential benefits such as shorter hospital stays, lower estimated blood loss, and comparable complication rates.