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Received:January 02, 2024 Published Online:May 20, 2024
Received:January 02, 2024 Published Online:May 20, 2024
中文摘要: 目的 运用Meta分析比较单侧双通道脊柱技术（unilateral biportal endoscopy, UBE）与单通道脊柱内镜技术（unilateral endoscopy, UE）治疗腰椎退行性疾病（lumbar degenerative diseases, LDD）的疗效，为临床治疗选择提供参考。 方法 检索PubMed、Web of Science、万方数据库、中国知网（CNKI）等数据库中UBE或UE治疗LDD的文献，检索日期为2019年3月至2023年11月，对纳入文献进行质量评价并提取相关数据进行Meta分析。结果指标：手术时间、术中出血量、术后住院时间、并发症发生率、术中透视次数、改良MacNab分级标准、腰痛或腿痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）。 结果 最终收用16篇文献，包括2篇随机对照研究以及14篇非随机对照研究，共1 398例患者（709例接受UBE治疗，689例接受UE治疗）。Meta分析结果显示：与单通道手术相比，双通道手术术中透视次数更多［MD=0.16，95%CI（0.05，0.26），P=0.004］；术后早期腰痛VAS评分［MD=-0.20，95%CI（-0.34，-0.07），P=0.004］、腿痛VAS评分［MD=-0.17，95%CI（-0.33，-0.01），P=0.03］及ODI［MD=-0.72，95%CI（-1.36，-0.08），P=0.03］均更低。亚组分析显示：针对LSS，与单通道手术相比，双通道手术时间更短［MD=-10.28，95%CI（-16.74， -3.82），P＜0.01］,术后腰痛VAS评分更好［MD=-0.22，95%CI（-0.42 -0.01），P=0.04］；针对LDH，与单通道手术相比，双通道手术时间更长［MD=14.45，95%CI（4.07，24.84），P＜0.01］,术中失血量更多［MD=29.40，95%CI（12.52，46.28），P＜0.01］,但术后ODI更好［MD=-0.84，95%CI（-1.39，-0.29），P＜0.01］。 结论 对于LSS，UBE手术时间较短;而针对于LDH，BE具有创伤更小、手术时间更短、出血更少等优势。此外，UBE可能在缓解术后早期腰痛腿痛中更具优势。
Abstract:Objective Meta-analysis was used to compare the efficacy of unilateral biportal endoscopy (UBE) and unilateral endoscopy(UE) in the treatment of lumbar degenerative diseases (LDD), in order to provide a reference for clinical treatment selection. Methods By searching the literature on UBE or UE treatment of LDD in PubMed, Web of Science, Wanfang database, CNKI and other databases, with searching date from March 2019 to November 2023. The quality of the collected literature was evaluated and the relevant outcome data were extracted, then Meta-analysis was conducted. The outcome indicators included: operative time, intraoperative blood loss, postoperative hospital stay, complication rate, number of intraoperative fluoroscopies, modified MacNab grading scale, visual analogue scale (VAS) for low back pain or leg pain, and Oswestry disability index (ODI). Results Sixteen papers (including 2 randomized controlled studies, 14 non-randomized controlled studies) with a total of 1 398 patients (including 709 patients treated with UBE , 689 patients treated with UE) were finally enrolled. The results of the Meta-analysis:compared with UE, the number of intraoperative fluoroscopy was higher in UBE ［MD=0.16,95%CI(0.05,0.26),P=0.004］; the VAS score of back and leg pain and ODI in the early postoperative period were better［MD=-0.20,95%CI(-0.34,-0.07),P=0.004; MD=-0.17,95%CI(-0.33,-0.01),P=0.03;MD=-0.72,95%CI(-1.36,-0.08),P=0.03］. Subgroup analysis: for LSS,the operation time of UBE was shorter than that of UE［MD=-10.28,95%CI(-16.74,-3.82),P＜0.01;the VAS score of postoperative back pain was better［MD=-0.22,95%CI(-0.42,-0.01),P=0.04］. For LDH,the operation time of UBE was longer than that of UE［MD=14.45,95%CI(4.07,24.84),P<0.01］; intraoperative blood loss was higher［MD=29.40,95%CI(12.52,46.28),P＜0.01］;however, postoperative ODI was better［MD=-0.84,95%CI(-1.39,-0.29),P＜0.01］. Conclusion The results demonstrate that for LSS, UBE has the potential to reduce operative time. While for LDH, UE still has the advantages of less trauma, shorter operative time, and less blood loss. and in addition, UBE may have the potential to alleviate early postoperative low back pain and leg pain.
keywords: Unilateral biportal endoscopy Unilateral endoscopy Lumbar degenerative diseases Meta-analysis
文章编号： 中图分类号：R681.5 文献标志码：A
基金项目:浙江省基础公益研究计划项目（LGF22H060025）；浙江省医药卫生科技项目（2023KY175）
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