CAJ | 학술논문

背景：有大量文献报道证实关节镜下射频松解治疗臀肌挛缩症在某些方面较开放手术好，但关于两种术式优劣比较，尚缺乏循证医学方面证据。 　　目的：采用Meta分析的方法对关节镜下射频松解与开放手术治疗臀肌挛缩症的疗效进行对比。 　　方法：检索EMbase、Medline、PubMed、OVID、Cochrane Library、Springerlink、万方数据库、中国知识资源总库、维普数据库，检索时间为1970年1月至2014年5月。收集关节镜下射频松解与开放手术治疗臀肌挛缩症疗效的相关文献，按纳入与排除标准筛选文献并对纳入文献进行质量评价，采用RevMan 5.2软件进行Meta分析。 　　结果与结论：共纳入14篇文献，病例数合计为830例，在其中关节镜下射频松解组394例，开放手术组436例。结果显示在主要观察指标中，关节镜下手术组术后疼痛发生率(RR=0.33，95%CI：0.27-0.42，P<0.001)及术后并发症发生率(OR=0.40，95%CI：0.23-0.70，P=0.001)比开放手术组低，而术后疗效比较两组间差异无显著性意义(OR=1.09，95%CI：0.52-2.26，P=0.82)；在次要观察指标分析中，关节镜组在术后住院天数、术后下床活动时间、切口长度方面优于开放手术组(P <0.05)，在其他2项指标两组之间差异无显著性意义(P >0.05)。结果证实，关节镜下组织松解治疗臀肌挛缩症与传统开放手术相比在疗效、复发率、手术时间等方面并无差异，而在切口长度美观、术后疼痛、术后下床活动时间、术后住院时间、术后并发症等方面占有明显优势。
배경：유대량문헌보도증실관절경하사빈송해치료둔기련축증재모사방면교개방수술호，단관우량충술식우렬비교，상결핍순증의학방면증거。 　　목적：채용Meta분석적방법대관절경하사빈송해여개방수술치료둔기련축증적료효진행대비。 　　방법：검색EMbase、Medline、PubMed、OVID、Cochrane Library、Springerlink、만방수거고、중국지식자원총고、유보수거고，검색시간위1970년1월지2014년5월。수집관절경하사빈송해여개방수술치료둔기련축증료효적상관문헌，안납입여배제표준사선문헌병대납입문헌진행질량평개，채용RevMan 5.2연건진행Meta분석。 　　결과여결론：공납입14편문헌，병례수합계위830례，재기중관절경하사빈송해조394례，개방수술조436례。결과현시재주요관찰지표중，관절경하수술조술후동통발생솔(RR=0.33，95%CI：0.27-0.42，P<0.001)급술후병발증발생솔(OR=0.40，95%CI：0.23-0.70，P=0.001)비개방수술조저，이술후료효비교량조간차이무현저성의의(OR=1.09，95%CI：0.52-2.26，P=0.82)；재차요관찰지표분석중，관절경조재술후주원천수、술후하상활동시간、절구장도방면우우개방수술조(P <0.05)，재기타2항지표량조지간차이무현저성의의(P >0.05)。결과증실，관절경하조직송해치료둔기련축증여전통개방수술상비재료효、복발솔、수술시간등방면병무차이，이재절구장도미관、술후동통、술후하상활동시간、술후주원시간、술후병발증등방면점유명현우세。
BACKGROUND:A large number of studies have reported that endoscopic radiofrequency ablation surgeries were better than traditional open surgeries for gluteal muscle contracture, but there is no meta-analysis on the clinical outcomes of endoscopic surgeries versus traditional open surgeries. OBJECTIVE:To evaluate the effects of endoscopic radiofrequency ablation surgeries versus traditional open surgeries in the treatment of gluteal muscle contracture. METHODS:Eligible studies were identified from electronic databases including EMbase, Medline, PubMed, OVID, Cochrane Library, Springerlink, CNKI, WanFang, and VIP between January 1970 and May 2014. The literatures about the clinical efficacy of endoscopic radiofrequency ablation surgeries versus traditional open surgeries in the treatment of gluteal muscle contracture were retrieved. We screened the retrieved literature according to the inclusion and exclusion criteria and performed a Meta analysis with the software RevMan 5.2 after identification of the relevant data. RESULTS AND CONCLUSION:A total of 830 patients from 14 studies were included for the analysis, including 394 patients who underwent endoscopic surgeries and 436 patients who underwent traditional open surgeries. Among the main outcomes measured, the incidence of postoperative pain (relative risk=0.33, 95%confidence interval (CI):0.27-0.42, P<0.001) and postoperative complications (odds ratio=0.40, 95%CI:0.23-0.70, P=0.001) in the endoscopic surgery group were significantly lower than that in the traditional open surgery group. The curative effects showed no significant difference between the two groups (odds ratio=1.09, 95%CI:0.52-2.26, P=0.82). Among the secondary outcomes measured, the incision length, postoperative off-bed activity time and postoperative hospitalization in the endoscopic surgery group were significantly better than that in the traditional open surgery group (P<0.05). There was no significant difference in the surgery duration and recurrence rate (P>0.05) between the two groups. Endoscopic radiofrequency ablation surgeries are similar to traditional open surgeries in the curative effects, recurrence rate and surgery duration, and are better than traditional open surgeries in the incisional length, postoperative pain, postoperative off-bed activity time, postoperative hospitalization and postoperative complication.