{"title":"内窥镜手术是腰椎间盘突出症安全有效的治疗方法吗？随机对照试验的元分析。","authors":"Bo-Tao Cai, Fan Yang, Deng-Chao Wang","doi":"10.1177/21925682241299326","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>Systematic Review.</p><p><strong>Objective: </strong>This meta-analysis systematically evaluates the safety and effectiveness of endoscopic techniques in the treatment of lumbar disc herniation (LDH).</p><p><strong>Methods: </strong>A comprehensive computerized search was conducted on PubMed, Embase, Cochrane Library, China National Biomedical Literature Database (CBM), VIP Database, China National Knowledge Infrastructure (CNKI) and Wanfang Database. Randomized controlled trials (RCTs) comparing endoscopic techniques with non-endoscopic techniques for the treatment of LDH were identified. Meta-analysis was performed using RevMan 5.4 software.</p><p><strong>Results: </strong>Seventeen RCTs involving 1748 LDH patients were analyzed. The meta-analysis revealed that, compared to the non-endoscopic discectomy (NED) group, the endoscopic discectomy (ED) group exhibited significantly lower intraoperative blood loss [MD = -74.45 mL, 95% CI (-124.88, -24.02), <i>P</i> = .004], shorter hospitalization duration [MD = -4.07 days, 95% CI (-6.67, -1.48), <i>P</i> = .002], lower Visual Analogue Scale (VAS) pain scores at the last follow-up [MD = -.35, 95% CI (-.63, -.07), <i>P</i> = .01], and a lower incidence of complications [RR = .35, 95% CI (.25, .48), <i>P</i> < .00001]. Moreover, the ED group exhibited a higher ratio of excellent and good therapeutic effects postoperatively [RR = 1.05, 95% CI (1.01, 1.10), <i>P</i> = .01]. However, there were no statistically significant differences between the 2 groups in terms of the Oswestry Disability Index (ODI) scores at the last follow-up [SMD = -.49, 95% CI (-1.14, .17), <i>P</i> = .14] and operation time [MD = -10.17 min, 95% CI (-27.05, 6.71), <i>P</i> = .24].</p><p><strong>Conclusion: </strong>Endoscopic techniques in the treatment of LDH exhibit significant superiority in intraoperative blood loss, hospitalization duration, postoperative pain, complication rates, and postoperative therapeutic effects. This provides patients with a safer and more effective treatment option.</p>","PeriodicalId":2,"journal":{"name":"ACS Applied Bio Materials","volume":null,"pages":null},"PeriodicalIF":4.6000,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559733/pdf/","citationCount":"0","resultStr":"{\"title\":\"Is Endoscopic Surgery a Safe and Effective Treatment for Lumbar Disc Herniation? A Meta-Analysis of Randomized Controlled Trials.\",\"authors\":\"Bo-Tao Cai, Fan Yang, Deng-Chao Wang\",\"doi\":\"10.1177/21925682241299326\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study design: </strong>Systematic Review.</p><p><strong>Objective: </strong>This meta-analysis systematically evaluates the safety and effectiveness of endoscopic techniques in the treatment of lumbar disc herniation (LDH).</p><p><strong>Methods: </strong>A comprehensive computerized search was conducted on PubMed, Embase, Cochrane Library, China National Biomedical Literature Database (CBM), VIP Database, China National Knowledge Infrastructure (CNKI) and Wanfang Database. Randomized controlled trials (RCTs) comparing endoscopic techniques with non-endoscopic techniques for the treatment of LDH were identified. Meta-analysis was performed using RevMan 5.4 software.</p><p><strong>Results: </strong>Seventeen RCTs involving 1748 LDH patients were analyzed. The meta-analysis revealed that, compared to the non-endoscopic discectomy (NED) group, the endoscopic discectomy (ED) group exhibited significantly lower intraoperative blood loss [MD = -74.45 mL, 95% CI (-124.88, -24.02), <i>P</i> = .004], shorter hospitalization duration [MD = -4.07 days, 95% CI (-6.67, -1.48), <i>P</i> = .002], lower Visual Analogue Scale (VAS) pain scores at the last follow-up [MD = -.35, 95% CI (-.63, -.07), <i>P</i> = .01], and a lower incidence of complications [RR = .35, 95% CI (.25, .48), <i>P</i> < .00001]. Moreover, the ED group exhibited a higher ratio of excellent and good therapeutic effects postoperatively [RR = 1.05, 95% CI (1.01, 1.10), <i>P</i> = .01]. However, there were no statistically significant differences between the 2 groups in terms of the Oswestry Disability Index (ODI) scores at the last follow-up [SMD = -.49, 95% CI (-1.14, .17), <i>P</i> = .14] and operation time [MD = -10.17 min, 95% CI (-27.05, 6.71), <i>P</i> = .24].</p><p><strong>Conclusion: </strong>Endoscopic techniques in the treatment of LDH exhibit significant superiority in intraoperative blood loss, hospitalization duration, postoperative pain, complication rates, and postoperative therapeutic effects. This provides patients with a safer and more effective treatment option.</p>\",\"PeriodicalId\":2,\"journal\":{\"name\":\"ACS Applied Bio Materials\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":4.6000,\"publicationDate\":\"2024-11-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559733/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"ACS Applied Bio Materials\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1177/21925682241299326\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"MATERIALS SCIENCE, BIOMATERIALS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"ACS Applied Bio Materials","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/21925682241299326","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MATERIALS SCIENCE, BIOMATERIALS","Score":null,"Total":0}
引用次数: 0
摘要
研究设计系统综述：本荟萃分析系统评估了内窥镜技术治疗腰椎间盘突出症（LDH）的安全性和有效性：在PubMed、Embase、Cochrane图书馆、中国国家生物医学文献数据库（CBM）、VIP数据库、中国国家知识基础设施（CNKI）和万方数据库中进行了全面的计算机检索。研究发现了比较内镜技术与非内镜技术治疗 LDH 的随机对照试验（RCT）。使用RevMan 5.4软件进行Meta分析：结果：分析了17项RCT，涉及1748名LDH患者。荟萃分析表明，与非内镜椎间盘切除术（NED）组相比，内镜椎间盘切除术（ED）组的术中失血量明显更少[MD = -74.45 mL，95% CI (-124.88, -24.02)，P = .004]，住院时间更短[MD = -4.07天，95% CI (-6.67, -1.48), P = .002]，最后一次随访时视觉模拟量表（VAS）疼痛评分较低[MD = -.35, 95% CI (-.63, -.07), P = .01]，并发症发生率较低[RR = .35, 95% CI (.25, .48), P < .00001]。此外，ED 组的术后治疗效果优和良的比例更高[RR = 1.05，95% CI (1.01，1.10)，P = .01]。然而，在最后一次随访时的Oswestry残疾指数（ODI）评分[SMD = -.49, 95% CI (-1.14, .17)，P = .14]和手术时间[MD = -10.17 min, 95% CI (-27.05, 6.71)，P = .24]方面，两组间无统计学差异：结论：内窥镜技术治疗 LDH 在术中失血量、住院时间、术后疼痛、并发症发生率和术后治疗效果方面均有明显优势。这为患者提供了更安全、更有效的治疗选择。
Is Endoscopic Surgery a Safe and Effective Treatment for Lumbar Disc Herniation? A Meta-Analysis of Randomized Controlled Trials.
Study design: Systematic Review.
Objective: This meta-analysis systematically evaluates the safety and effectiveness of endoscopic techniques in the treatment of lumbar disc herniation (LDH).
Methods: A comprehensive computerized search was conducted on PubMed, Embase, Cochrane Library, China National Biomedical Literature Database (CBM), VIP Database, China National Knowledge Infrastructure (CNKI) and Wanfang Database. Randomized controlled trials (RCTs) comparing endoscopic techniques with non-endoscopic techniques for the treatment of LDH were identified. Meta-analysis was performed using RevMan 5.4 software.
Results: Seventeen RCTs involving 1748 LDH patients were analyzed. The meta-analysis revealed that, compared to the non-endoscopic discectomy (NED) group, the endoscopic discectomy (ED) group exhibited significantly lower intraoperative blood loss [MD = -74.45 mL, 95% CI (-124.88, -24.02), P = .004], shorter hospitalization duration [MD = -4.07 days, 95% CI (-6.67, -1.48), P = .002], lower Visual Analogue Scale (VAS) pain scores at the last follow-up [MD = -.35, 95% CI (-.63, -.07), P = .01], and a lower incidence of complications [RR = .35, 95% CI (.25, .48), P < .00001]. Moreover, the ED group exhibited a higher ratio of excellent and good therapeutic effects postoperatively [RR = 1.05, 95% CI (1.01, 1.10), P = .01]. However, there were no statistically significant differences between the 2 groups in terms of the Oswestry Disability Index (ODI) scores at the last follow-up [SMD = -.49, 95% CI (-1.14, .17), P = .14] and operation time [MD = -10.17 min, 95% CI (-27.05, 6.71), P = .24].
Conclusion: Endoscopic techniques in the treatment of LDH exhibit significant superiority in intraoperative blood loss, hospitalization duration, postoperative pain, complication rates, and postoperative therapeutic effects. This provides patients with a safer and more effective treatment option.
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