CAJ | 학술논문

背景：显微椎间盘切除与显微内窥镜下椎间盘切除是两种安全有效的椎间盘手术方式，目前关于两种显微技术间的比较研究较少，各研究得出的结论不太一致。 　　目的：通过Meta分析比较显微椎间盘切除与显微内窥镜下椎间盘切除治疗椎间盘突出症的安全性和有效性。方法：检索Cochrane Library、PubMed、CNKI、VIP、Web of Science、万方等数据库，时间限制均为建库到2013年11月；并手工检索相关杂志，收集显微椎间盘切除和显微内窥镜下椎间盘切除治疗腰椎间盘突出症的随机对照试验，对纳入研究按RevMan 5.2软件内条目进行质量评价，进行Meta分析。 　　结果与结论：共纳入5个随机对照试验，共1430例患者。Meta分析结果显示：在住院时间[MD=-0.19(-0.43，0.05)，P=0.13]、Oswestry 功能障碍指数改善率[MD=2.78(-0.15，5.72)，P=0.06]、目测类比评分改善率[MD=1.96(-0.29，4.21)，P=0.09]、神经根损伤方面[RR=0.20(0.03，1.12)，P=0.07]，两种治疗方式差异无显著性意义。与显微内窥镜下椎间盘切除相比，显微椎间盘切除手术时间短[MD=-10.13(-14.06，-6.21)， P<0.00001]，术中出血量少[MD=-24.27(-39.45，-9.08)，P=0.002]，硬脊膜撕裂发生率低[RR=0.28(0.11，0.68)，P=0.005]，复发率低[RR=0.34(0.14，0.83)，P=0.02]。提示目前在相同条件下显微椎间盘切除治疗椎间盘突出症更为安全有效，但是随着技术及设备的更新上述结论不一定永远不变，建议临床医生根据实际情况选择治疗方式。该课题尚需更多高质量的随机对照试验验证，同时应及时更新。
배경：현미추간반절제여현미내규경하추간반절제시량충안전유효적추간반수술방식，목전관우량충현미기술간적비교연구교소，각연구득출적결론불태일치。 　　목적：통과Meta분석비교현미추간반절제여현미내규경하추간반절제치료추간반돌출증적안전성화유효성。방법：검색Cochrane Library、PubMed、CNKI、VIP、Web of Science、만방등수거고，시간한제균위건고도2013년11월；병수공검색상관잡지，수집현미추간반절제화현미내규경하추간반절제치료요추간반돌출증적수궤대조시험，대납입연구안RevMan 5.2연건내조목진행질량평개，진행Meta분석。 　　결과여결론：공납입5개수궤대조시험，공1430례환자。Meta분석결과현시：재주원시간[MD=-0.19(-0.43，0.05)，P=0.13]、Oswestry 공능장애지수개선솔[MD=2.78(-0.15，5.72)，P=0.06]、목측류비평분개선솔[MD=1.96(-0.29，4.21)，P=0.09]、신경근손상방면[RR=0.20(0.03，1.12)，P=0.07]，량충치료방식차이무현저성의의。여현미내규경하추간반절제상비，현미추간반절제수술시간단[MD=-10.13(-14.06，-6.21)， P<0.00001]，술중출혈량소[MD=-24.27(-39.45，-9.08)，P=0.002]，경척막시렬발생솔저[RR=0.28(0.11，0.68)，P=0.005]，복발솔저[RR=0.34(0.14，0.83)，P=0.02]。제시목전재상동조건하현미추간반절제치료추간반돌출증경위안전유효，단시수착기술급설비적경신상술결론불일정영원불변，건의림상의생근거실제정황선택치료방식。해과제상수경다고질량적수궤대조시험험증，동시응급시경신。
BACKGROUND:Microsurgical discectomy and microendoscopic discectomy are effective safe methods for treatment of lumbar disc herniations. Currently, the comparative study on two kinds of microtechnology was less, and the conclusion of each study is different. OBJECTIVE:To compare the safety and effectiveness between microsurgical discectomy and microendoscopic discectomy for treatment of lumbar disc herniations using meta-analysis. METHODS:Cochrane Library, PubMed, CNKI, VIP, Web of Science and Wanfang were searched for articles published from building to November 2013. Related journals were retrieved by hand. Randomized control ed trials of microsurgical discectomy and microendoscopic discectomy for treatment of lumbar disc herniations were col ected. Qualities of included studies were evaluated using RevMan 5.2 software, and then analyzed by meta-analysis. RESULTS AND CONCLUSION:A total of 5 randomized control ed trials involving 1 430 cases were included. The results of meta-analysis indicated that no significant difference between microsurgical discectomy and microendoscopic discectomy groups was detected in the length of hospital stay [MD=-0.19 (-0.43, 0.05), P=0.13], the improvement rate of Oswestry disability index [MD=2.78 (-0.15, 5.72), P=0.06], the improvement rate of visual analogue scale [MD=1.96 (-0.29, 4.21), P=0.09] and the root injure [RR=0.20 (0.03, 1.12), P=0.07]. Compared with microendoscopic discectomy, microsurgical discectomy showed less surgical time [MD=-10.13 (-14.06,-6.21), P<0.000 01], less blood loss [MD=-24.27 (-39.45,-9.08), P=0.002], lower incidence of dural tear [RR=0.28(0.11, 0.68), P=0.005], lower risk of recurrent herniation [RR=0.34 (0.14, 0.83), P=0.02]. Above data showed that microsurgical discectomy for lumbar disc herniations was safe and effective under the same condition, but with updated technology and equipment, above conclusion is not necessarily always the same. We suggested that clinical physicians should choose a manner based on practical condition. This topic stil requires the verification of more high-quality randomized control ed trials, and the conclusion should be updated promptly.