目的 通过Meta分析比较单侧双通道内镜技术(unilateral biportal endoscopy, UBE)与显微内镜技术(Micro endoscopic discectomy, MED)治疗退变性腰椎管狭窄症的疗效,为临床决策提供指导意见。方法 分别检索 Pubmed、Web of Science、Cochrane Library、Embase、万方数据库、中国知网(CNKI)、维普、中国生物医学数据库(CBM)等数据库中治疗退变性腰椎管狭窄症的中英文文献,收集关于UBE与MED治疗的临床对照研究,检索时限为自建库起至2021年6月。根据纳入与排除标准对文献进行筛选、质量评价、数据提取,并通过RevMan 5.4软件与Stata 15.1软件综合对提取出的数据进行Meta分析。评价指标包括:手术时间、末次随访时背痛视觉模拟量表(VAS)评分、末次随访时腿痛VAS评分、末次随访时Oswestry功能障碍指数 (ODI)评分、并发症发生率、术后硬膜扩张、术中出血量。结果 最终纳入10篇文献[3篇随机对照试验(randomized controlled trial,RCT)、7篇非随机对照试验],受试者共计880例,其中单侧双通道内镜组407例,显微内镜组473例。Meta分析结果显示,两组的术后硬膜扩张程度、手术时间、术中失血量、末次随访时ODI评分差异无统计学意义(P>0.05);与显微内镜组相比,单侧双通道内镜组末次随访时的腰痛VAS评分较小[MD=-0.18,95%CI(-0.31,-0.05),P=0.006],腿痛VAS评分较小[MD=-0.15,95%CI(-0.27,-0.04),P=0.008],但并发症发生率较高[OR=0.54,95%CI(0.31,0.94),P =0.03]。结论 MED与UBE都是治疗退变性腰椎管狭窄症的有效方式,MED在减少并发症发生率方面优于UBE,而UBE具有术后腰腿痛VAS评分改善效果好的特点,在选择手术方案时应综合考虑。

Objective To provide instructions to clinical decision-making by comparing the efficacy of unilateral biportal endoscopic(UBE) and microendoscopic discectomy (MED) in treating degenerative lumbar spinal stenosis(LSS). Methods Chinese and English study papers on UBE and MED for degenerative LSS were respectively searched in PubMed, Web of Science,Cochrane Library,Embase,Wanfang Database,CNKI,VIP,China Biologicl Medicine (CBM) and other databases, and controlled clinical studies on UBE and MED therapies with the search duration starting from the setup of databases to March 2020 were collected. The study documents were subject to the screening, quality evaluation and data extraction based on the inclusion and exclusion criteria. RevMan 5.4 and Stata15.1 software were applied for meta-analysis on the extracted data. The operation duration, blood loss, visual analogue scake (VAS) score of back and leg pain in the last follow-up, disability index (ODI), complication rates, postoperative dural distension, and intraoperative blood loss were included as comparator. Results Finally, 10 study papers (3 randomized controlled trials (RCTs) and 7 non-randomized controlled trials (N-RCTs)) involving a total of 880 patients were included, and 407 UBE cases and 473 MED cases were noted. The meta-analysis results showed that differences in the degree of dura extension, operation duration, intra-operative blood loss and ODI between groups weren't statistically significant. Compared with MED group, the lower VAS scores of the back pain in the last follow-up [MD=-0.18,95%CI(-0.31,-0.05),P=0.006] and leg pain [MD=-0.15,95%CI(-0.27,-0.04),P=0.008] as well as higher incidence rate of complications[OR=0.54,95%CI(0.31,0.94),P=0.03] were noted in UBE group. Conclusion Both UBE and MED are both effective treatments of degenerative LSS, MED is found to be superior to UBE in reducing the complications, while UBE is advantageous in improving VAS scores of the post-operative back pain, and overall consideration should be taken in the selection on surgery program.