单侧双通道内镜与通道显微内镜治疗腰椎管狭窄症的meta分析

doi:10.3877/cma.j.issn.2096-0263.2023.03.007

目的

通过Meta分析比较单侧双通道内镜手术（UBES）与通道显微内镜手术（TMS）安全性及有效性的差异。

方法

计算机检索在Embase、Pubmed、Central、Cinahl、PQDT、Cochrane Library、CBM、CNKI等数据库公开发表的单侧双通道内镜手术和显微内镜手术治疗腰椎管狭窄症的文献，依据检索策略，共检索到相关文献784篇，并最终纳入14篇文献。对文献依据Cochrane系统评价方法学进行质量评价，提取数据后，用RevMan 5.4软件进行Meta分析。

结果

通过比较发现，UBES治疗腰椎管狭窄症时，在术后VAS下肢痛评分在术后1周内[95% CI：-1.05，-0.37，P<0.001]、术后VAS腰痛评分在术后1周内[95% CI：-1.77，-1.14，P<0.001]、术后ODI评分在术后1~3月[95% CI：-2.06，-0.05，P=0.04]、术后离床活动时间[95% CI：-12.09，-6.43，P<0.001]、住院时间[95% CI：-6.63，-1.09，P=0.006]、术中出血量[95% CI：-112.12，-36.37，P<0.001]及术后优良率（改良Macnab标准）[95% CI：1.05，3.46，P=0.04]评定上均优于TMS组。而两组手术方式在术后1周~1个月、术后1~3个月的下肢痛VAS评分和腰痛VAS评分，术后1月内ODI评分，手术时间及术后总并发症的结果差异均无统计学意义。

结论

在治疗腰椎管狭窄时，相较于TMS组，UBES组术后具有更短的住院时间、更早的离床活动时间、更少的出血量及更优的疼痛症状改善。

关键词: 腰椎管狭窄症, 单侧双通道内镜技术, 通道显微内镜技术, Meta分析

Objective

This meta-analysis compared the safety and efficacy of unilateral biportal endoscopic surgery (UBES) and tubular microendoscopic surgery (TMS).

Methods

Computer searches were performed on Embase, PubMed, Central, Cochrane Library, CNKI, and Wanfang databases for published literature on UBES and TMS in lumbar spinal stenosis. A total of 784 related studies were retrieved, and 14 were finally included. Literature quality was evaluated using the Cochrane systematic review methodology. After data extraction, a meta-analysis was performed using the ReviewManager 5.4 software.

Results

By comparison, UBES for lumbar spinal stenosis was found to be associated with postoperative VAS lower extremity pain scores at 1 week postoperatively [95% CI: -1.05, -0.37, P<0.001], postoperative VAS low back pain scores at 1 week postoperatively [95% CI: -1.77, -1.14, P<0.001], postoperative ODI scores at 1-3 months postoperatively [95% CI: -2.06, -0.05, P=0.04], postoperative time out of bed [95% CI: -12.09, -6.43, P<0.001], hospital stay [95% CI: -6.63, -1.09, P=0.006], intraoperative bleeding [95% CI: -112.12, -36.37, P<0.001] and postoperative excellent rate (modified Macnab criteria) [95% CI: 1.05, 3.46, P=0.04] were rated better than the TMS group. In contrast, there was no significant difference between the two surgical approaches in the outcomes of lower extremity pain VAS scores and low back pain VAS scores at 1 week to 1 month and 1 to 3 months post-surgery, ODI scores at 1 month post-surgery, time to surgery and total post-surgery complications.

Conclusion

In the treatment of lumbar stenosis, the UBES group had a shorter hospital stay, an earlier time out of bed, less bleeding, and a better improvement in pain symptoms than the TMS group.

Key words: Lumbar Spinal Stenosis, Unilateral biportal endoscopic, Tubular microendoscopic, Meta-analysis

图1 文献筛选流程图

表1 纳入文献研究基本特征表

作者	研究设计方法	国家	年份	组别	患者例数	年龄（岁，±s）	性别（男/女）	纳入指标	纽卡斯尔-渥太华量表
Aygun等^[8]	Prospective	沙特阿拉伯Saudi Arabia	2021	UBES	77	64.64±10.09	44/33	⑻	9
Aygun等^[8]	Prospective	沙特阿拉伯Saudi Arabia	2021	TMS	77	65.01±9.24	50/27	⑻	9
Carrascosa-Granada等^[9]	Prospective	西班牙Spain	2020	UBES	10	73.5±10.51	4/6	⑴⑵⑶⑷⑺	8
Carrascosa-Granada等^[9]	Prospective	西班牙Spain	2020	TMS	10	69.7±8.64	4/6	⑴⑵⑶⑷⑺	8
Gatam等^[10]	Retrospective	印度尼西亚Indonesia	2021	UBES	72	55.1±5.12	26/46	⑵	7
Gatam等^[10]	Retrospective	印度尼西亚Indonesia	2021	TMS	73	52.3±6.13	28/45	⑵	7
Heo等^[11]	Prospective	韩国Korea	2018	UBES	46	65.8±8.9	18/28	⑴⑵⑶⑺	7
Heo等^[11]	Prospective	韩国Korea	2018	TMS	42	63.6±10.5	16/26	⑴⑵⑶⑺	7
Hua等^[12]	Retrospective	中国China	2020	UBES	32	56.7±9.1	12/20	⑴⑵⑶⑷⑸⑹⑺⑻	8
Hua等^[12]	Retrospective	中国China	2020	TMS	80	58.8±10.5	32/48	⑴⑵⑶⑷⑸⑹⑺⑻	8
Ito等^[13]	Retrospective	日本Japan	2021	UBES	42	66.3±12.3	28/14	⑶⑺	7
Ito等^[13]	Retrospective	日本Japan	2021	TMS	139	65.0±11.1	71/68	⑶⑺	7
Kang等^[14]	Prospective	韩国Korea	2019	UBES	32	65.1±8.6	18/14	⑶⑺⑻	7
Kang等^[14]	Prospective	韩国Korea	2019	TMS	30	67.2±9.5	14/16	⑶⑺⑻	7
Kim等^[15]	Retrospective	韩国Korea	2021	UBES	32	70.5±8.26	17/15	⑴⑵⑶⑸⑹⑺⑻	7
Kim等^[15]	Retrospective	韩国Korea	2021	TMS	55	67.3±10.7	25/30	⑴⑵⑶⑸⑹⑺⑻	7
Min等^[16]	Retrospective	韩国Korea	2019	UBES	54	65.74±10.52	27/27	⑴⑵⑶⑸⑹⑺	8
Min等^[16]	Retrospective	韩国Korea	2019	TMS	35	66.74±7.96	19/16	⑴⑵⑶⑸⑹⑺	8
赵子豪等^[17]	Retrospective	中国China	2021	UBES	34	65.71±10.55	16/18	⑴⑵⑶⑸⑹	7
赵子豪等^[17]	Retrospective	中国China	2021	TMS	31	66.53±8.17	15/16	⑴⑵⑶⑸⑹	7
庹伟等^[18]	Retrospective	中国China	2021	UBES	22	59.1±11.7	12/10	⑴⑵⑷⑺	7
庹伟等^[18]	Retrospective	中国China	2021	TMS	25	58.3±8.7	11/14	⑴⑵⑷⑺	7
Choi等^[19]	Retrospective	韩国Korea	2019	UBES	35	65.4±11.8	14/21	⑴⑺	7
Choi等^[19]	Retrospective	韩国Korea	2019	TMS	30	65.2±12.0	17/13	⑴⑺	7
Heo等^[20]	Prospective	韩国Korea	2019	UBES	37	66.7±9.4	15/22	⑴⑵⑶⑺	7
Heo等^[20]	Prospective	韩国Korea	2019	TMS	33	63.4±11.1	12/21	⑴⑵⑶⑺	7
Park等^[21]	Prospective	韩国Korea	2019	UBES	32	NA	13/19	⑴⑵⑶⑹⑺	8
Park等^[21]	Prospective	韩国Korea	2019	TMS	32	NA	18/14	⑴⑵⑶⑹⑺	8

表1 纳入文献研究基本特征表

作者	研究设计方法	国家	年份	组别	患者例数	年龄（岁，±s）	性别（男/女）	纳入指标	纽卡斯尔-渥太华量表
Aygun等^[8]	Prospective	沙特阿拉伯Saudi Arabia	2021	UBES	77	64.64±10.09	44/33	⑻	9
Aygun等^[8]	Prospective	沙特阿拉伯Saudi Arabia	2021	TMS	77	65.01±9.24	50/27	⑻	9
Carrascosa-Granada等^[9]	Prospective	西班牙Spain	2020	UBES	10	73.5±10.51	4/6	⑴⑵⑶⑷⑺	8
Carrascosa-Granada等^[9]	Prospective	西班牙Spain	2020	TMS	10	69.7±8.64	4/6	⑴⑵⑶⑷⑺	8
Gatam等^[10]	Retrospective	印度尼西亚Indonesia	2021	UBES	72	55.1±5.12	26/46	⑵	7
Gatam等^[10]	Retrospective	印度尼西亚Indonesia	2021	TMS	73	52.3±6.13	28/45	⑵	7
Heo等^[11]	Prospective	韩国Korea	2018	UBES	46	65.8±8.9	18/28	⑴⑵⑶⑺	7
Heo等^[11]	Prospective	韩国Korea	2018	TMS	42	63.6±10.5	16/26	⑴⑵⑶⑺	7
Hua等^[12]	Retrospective	中国China	2020	UBES	32	56.7±9.1	12/20	⑴⑵⑶⑷⑸⑹⑺⑻	8
Hua等^[12]	Retrospective	中国China	2020	TMS	80	58.8±10.5	32/48	⑴⑵⑶⑷⑸⑹⑺⑻	8
Ito等^[13]	Retrospective	日本Japan	2021	UBES	42	66.3±12.3	28/14	⑶⑺	7
Ito等^[13]	Retrospective	日本Japan	2021	TMS	139	65.0±11.1	71/68	⑶⑺	7
Kang等^[14]	Prospective	韩国Korea	2019	UBES	32	65.1±8.6	18/14	⑶⑺⑻	7
Kang等^[14]	Prospective	韩国Korea	2019	TMS	30	67.2±9.5	14/16	⑶⑺⑻	7
Kim等^[15]	Retrospective	韩国Korea	2021	UBES	32	70.5±8.26	17/15	⑴⑵⑶⑸⑹⑺⑻	7
Kim等^[15]	Retrospective	韩国Korea	2021	TMS	55	67.3±10.7	25/30	⑴⑵⑶⑸⑹⑺⑻	7
Min等^[16]	Retrospective	韩国Korea	2019	UBES	54	65.74±10.52	27/27	⑴⑵⑶⑸⑹⑺	8
Min等^[16]	Retrospective	韩国Korea	2019	TMS	35	66.74±7.96	19/16	⑴⑵⑶⑸⑹⑺	8
赵子豪等^[17]	Retrospective	中国China	2021	UBES	34	65.71±10.55	16/18	⑴⑵⑶⑸⑹	7
赵子豪等^[17]	Retrospective	中国China	2021	TMS	31	66.53±8.17	15/16	⑴⑵⑶⑸⑹	7
庹伟等^[18]	Retrospective	中国China	2021	UBES	22	59.1±11.7	12/10	⑴⑵⑷⑺	7
庹伟等^[18]	Retrospective	中国China	2021	TMS	25	58.3±8.7	11/14	⑴⑵⑷⑺	7
Choi等^[19]	Retrospective	韩国Korea	2019	UBES	35	65.4±11.8	14/21	⑴⑺	7
Choi等^[19]	Retrospective	韩国Korea	2019	TMS	30	65.2±12.0	17/13	⑴⑺	7
Heo等^[20]	Prospective	韩国Korea	2019	UBES	37	66.7±9.4	15/22	⑴⑵⑶⑺	7
Heo等^[20]	Prospective	韩国Korea	2019	TMS	33	63.4±11.1	12/21	⑴⑵⑶⑺	7
Park等^[21]	Prospective	韩国Korea	2019	UBES	32	NA	13/19	⑴⑵⑶⑹⑺	8
Park等^[21]	Prospective	韩国Korea	2019	TMS	32	NA	18/14	⑴⑵⑶⑹⑺	8

图5 UBES与TMS治疗腰椎管狭窄症术后ODI评分的Meta分析

图9 UBES与TMS治疗腰椎管狭窄症住院时间的Meta分析

图12 结局指标漏斗图（a：术后腰痛VAS评分（1周内、1周~1月、1~3月）、b：术后下肢痛VAS评分（1周内、1周~1月、1~3月）、c：术后ODI评分（1月内、1~3月）、d：手术时间、e：术中出血量、f：离床活动时间、g：住院时间、h：术后总并发症、i：术后优良率）

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Efficacy and safety of unilateral biportal endoscopy versus tubular microendoscopic for lumbar spinal stenosis: A systematic review and meta-analysis

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Efficacy and safety of unilateral biportal endoscopy versus tubular microendoscopic for lumbar spinal stenosis: A systematic review and meta-analysis