目的:系统分析PETD与PEID治疗单节段LDH的相关的术中情况及术后疗效。方法:对Pub-Med、Med of science、中国期刊全文数据库(CNKI)、维普数据库、万方数据库进行关于PELD相关文献进行检索,语种为英文或中文。由两位作者独立对各研究进...目的:系统分析PETD与PEID治疗单节段LDH的相关的术中情况及术后疗效。方法:对Pub-Med、Med of science、中国期刊全文数据库(CNKI)、维普数据库、万方数据库进行关于PELD相关文献进行检索,语种为英文或中文。由两位作者独立对各研究进行评估,并将各数据导入Revman 5.3软件进行Meta分析,来评估两种入路技术在各种结局指标的统计学意义。结果:最终共计15篇研究被纳入,共计1422例患者被纳入分析。PETD与PEID比较:后者手术时间更短(MD = 6.11, 95% CI: −1.86~14.07),而差异不存在统计学意义(P > 0.05);PEID术中X光线透视次数更少(MD = 9.05, 95% CI: 7.17~10.92, P 0.05);两组的术后1天腰痛VAS变化值(MD = −0.04, 95% CI: −0.34~0.27),ODI变化值(MD = −0.64, 95% CI: −0.22~0.95)、术后1月腰痛VAS变化值(MD = −0.04, 95% CI: −0.34~0.27)和ODI变化值(MD = 0.21, 95% CI: −1.08~1.49)、术后3月腰痛VAS变化值(MD = −0.05, 95% CI: −0.24~0.14)和ODI变化值(MD = −0.88, 95% CI: −1.95~0.19)、术后6月腰痛VAS变化值(MD = 0.04, 95% CI: −0.20~0.29)和ODI变化值(MD = 0.61, 95% CI: −1.31~2.53)、术后12月腰痛VAS变化值(MD = 0.05, 95% CI: −0.09~0.19)和ODI变化值(MD = −0.20, 95% CI: −0.95~0.56),均无统计学意义(P > 0.05)。结论:PETD和PEID治疗单节段LDH均具有良好的临床疗效,但PEID术中X光线透视次数更少,且手术时间可能更短。PETD更具微创性,能够更少破坏脊柱骨性结构,短期内更好地缓解腰腿痛。Objective: To systematically analyze the intraoperative and postoperative effects of two approaches of percutaneous spinal endoscopy in the treatment of lumbar disc herniation. Methods: Clinical studies related to PELD were searched in English or Chinese by Pub-Med, Med of Science, China Journal Full-text Database (CNKI), VIP database and Wanfang database. Two authors independently assessed the quality of each study, and a meta-analysis of each data was performed using Revman 5.3 software to evaluate the statistical significance of the two approach techniques in various outcome indicators. Results: A total of 15 studies were eventually included, with a total of 1422 patients included in the analysis. Comparison between PETD and PEID: the operation time of the latter group was shorter than that of the former group (MD = 6.11, 95% CI: −1.86~14.07), but the difference was not statistically significant (P > 0.05). The latter had fewer intraoperative fluoroscopy times than the former (MD = 9.05, 95% CI: 7.17~10.92, P 0.05). VAS change value of low back pain 1 day after surgery (MD = −0.04, 95% CI: −0.34~0.27), ODI change value (MD = −0.64, 95% CI: −0.22~0.95), VAS change value of low back pain 1 month after surgery (MD = −0.04, 95% CI: −0.34~0.27) and ODI (MD = 0.21, 95% CI: −1.08~1.49), VAS change value of low back pain 3 months after surgery (MD = −0.05, 95% CI: −0.24~0.14) and ODI change value (MD = −0.88, 95% CI: −1.95~0.19), the change of VAS for low back pain 6 months after surgery (MD = 0.04, 95% CI: −0.20~0.29) and ODI change value (MD = 0.61, 95% CI: −1.31~2.53), the change of VAS for low back pain 12 months after surgery (MD = 0.05, 95% CI: −0.09~0.19) and ODI change value (MD = −0.20, 95% CI: −0.95~0.56) were not statistically significant (P > 0.05). Conclusion: Both PETD and PEID have good clinical efficacy in the treatment of lumbar disc herniation, but PEID may have shorter operative time and fewer intraoperative X-ray times. PETD is more minimally invasive, can destroy less spinal bone structure, and can better relieve back and leg pain in the short term.展开更多
Background: Surgical treatment of lumbar disc herniation is a widely debated topic, with several techniques available. Percutaneous endoscopic discectomy (PELD) has gained popularity due to its lower invasiveness comp...Background: Surgical treatment of lumbar disc herniation is a widely debated topic, with several techniques available. Percutaneous endoscopic discectomy (PELD) has gained popularity due to its lower invasiveness compared to conventional techniques such as microdiscectomy/open lumbar microdiscectomy (OLMD)/tubular microdiscectomy (TMD). However, evidence on the effectiveness, recovery time and complications of these techniques is not yet clearly established. This systematic review aims to compare the preoperative and postoperative outcomes of both techniques. Methods: A comprehensive search was performed in databases including PubMed and Cochrane, following strict inclusion and exclusion criteria. Comparative studies and narrative reviews on PELD and OLMD/TMD published between 2019 and 2024 were included. Key outcomes considered were pre- and postoperative Visual Analogue Scale (VAS), hospitalization time, time to return to work, and postoperative complications. Results: The reviewed studies indicated that PELD is associated with a greater reduction in postoperative pain compared to OLMD/TMD, with a significant decrease in VAS, according to the study by Priola et al. (2019). The hospital stay was also shorter for patients undergoing PELD, averaging 2 days compared to OLMD/TMD. Furthermore, PELD favored a faster return to work and had a lower rate of postoperative complications, such as dural tears and reoperations, compared to OLMD/TMD. Conclusions: PELD demonstrates clear advantages over OLMD/TMD in terms of pain reduction, shorter hospital stay, faster return to work, and fewer postoperative complications. However, the implementation of this technique requires a significant learning curve, suggesting that its effectiveness may vary depending on the surgeon’s experience. PELD should be considered a preferred option in the resection of lumbar disc herniations, especially in patients seeking a quick and less invasive recovery.展开更多
文摘目的:系统分析PETD与PEID治疗单节段LDH的相关的术中情况及术后疗效。方法:对Pub-Med、Med of science、中国期刊全文数据库(CNKI)、维普数据库、万方数据库进行关于PELD相关文献进行检索,语种为英文或中文。由两位作者独立对各研究进行评估,并将各数据导入Revman 5.3软件进行Meta分析,来评估两种入路技术在各种结局指标的统计学意义。结果:最终共计15篇研究被纳入,共计1422例患者被纳入分析。PETD与PEID比较:后者手术时间更短(MD = 6.11, 95% CI: −1.86~14.07),而差异不存在统计学意义(P > 0.05);PEID术中X光线透视次数更少(MD = 9.05, 95% CI: 7.17~10.92, P 0.05);两组的术后1天腰痛VAS变化值(MD = −0.04, 95% CI: −0.34~0.27),ODI变化值(MD = −0.64, 95% CI: −0.22~0.95)、术后1月腰痛VAS变化值(MD = −0.04, 95% CI: −0.34~0.27)和ODI变化值(MD = 0.21, 95% CI: −1.08~1.49)、术后3月腰痛VAS变化值(MD = −0.05, 95% CI: −0.24~0.14)和ODI变化值(MD = −0.88, 95% CI: −1.95~0.19)、术后6月腰痛VAS变化值(MD = 0.04, 95% CI: −0.20~0.29)和ODI变化值(MD = 0.61, 95% CI: −1.31~2.53)、术后12月腰痛VAS变化值(MD = 0.05, 95% CI: −0.09~0.19)和ODI变化值(MD = −0.20, 95% CI: −0.95~0.56),均无统计学意义(P > 0.05)。结论:PETD和PEID治疗单节段LDH均具有良好的临床疗效,但PEID术中X光线透视次数更少,且手术时间可能更短。PETD更具微创性,能够更少破坏脊柱骨性结构,短期内更好地缓解腰腿痛。Objective: To systematically analyze the intraoperative and postoperative effects of two approaches of percutaneous spinal endoscopy in the treatment of lumbar disc herniation. Methods: Clinical studies related to PELD were searched in English or Chinese by Pub-Med, Med of Science, China Journal Full-text Database (CNKI), VIP database and Wanfang database. Two authors independently assessed the quality of each study, and a meta-analysis of each data was performed using Revman 5.3 software to evaluate the statistical significance of the two approach techniques in various outcome indicators. Results: A total of 15 studies were eventually included, with a total of 1422 patients included in the analysis. Comparison between PETD and PEID: the operation time of the latter group was shorter than that of the former group (MD = 6.11, 95% CI: −1.86~14.07), but the difference was not statistically significant (P > 0.05). The latter had fewer intraoperative fluoroscopy times than the former (MD = 9.05, 95% CI: 7.17~10.92, P 0.05). VAS change value of low back pain 1 day after surgery (MD = −0.04, 95% CI: −0.34~0.27), ODI change value (MD = −0.64, 95% CI: −0.22~0.95), VAS change value of low back pain 1 month after surgery (MD = −0.04, 95% CI: −0.34~0.27) and ODI (MD = 0.21, 95% CI: −1.08~1.49), VAS change value of low back pain 3 months after surgery (MD = −0.05, 95% CI: −0.24~0.14) and ODI change value (MD = −0.88, 95% CI: −1.95~0.19), the change of VAS for low back pain 6 months after surgery (MD = 0.04, 95% CI: −0.20~0.29) and ODI change value (MD = 0.61, 95% CI: −1.31~2.53), the change of VAS for low back pain 12 months after surgery (MD = 0.05, 95% CI: −0.09~0.19) and ODI change value (MD = −0.20, 95% CI: −0.95~0.56) were not statistically significant (P > 0.05). Conclusion: Both PETD and PEID have good clinical efficacy in the treatment of lumbar disc herniation, but PEID may have shorter operative time and fewer intraoperative X-ray times. PETD is more minimally invasive, can destroy less spinal bone structure, and can better relieve back and leg pain in the short term.
文摘Background: Surgical treatment of lumbar disc herniation is a widely debated topic, with several techniques available. Percutaneous endoscopic discectomy (PELD) has gained popularity due to its lower invasiveness compared to conventional techniques such as microdiscectomy/open lumbar microdiscectomy (OLMD)/tubular microdiscectomy (TMD). However, evidence on the effectiveness, recovery time and complications of these techniques is not yet clearly established. This systematic review aims to compare the preoperative and postoperative outcomes of both techniques. Methods: A comprehensive search was performed in databases including PubMed and Cochrane, following strict inclusion and exclusion criteria. Comparative studies and narrative reviews on PELD and OLMD/TMD published between 2019 and 2024 were included. Key outcomes considered were pre- and postoperative Visual Analogue Scale (VAS), hospitalization time, time to return to work, and postoperative complications. Results: The reviewed studies indicated that PELD is associated with a greater reduction in postoperative pain compared to OLMD/TMD, with a significant decrease in VAS, according to the study by Priola et al. (2019). The hospital stay was also shorter for patients undergoing PELD, averaging 2 days compared to OLMD/TMD. Furthermore, PELD favored a faster return to work and had a lower rate of postoperative complications, such as dural tears and reoperations, compared to OLMD/TMD. Conclusions: PELD demonstrates clear advantages over OLMD/TMD in terms of pain reduction, shorter hospital stay, faster return to work, and fewer postoperative complications. However, the implementation of this technique requires a significant learning curve, suggesting that its effectiveness may vary depending on the surgeon’s experience. PELD should be considered a preferred option in the resection of lumbar disc herniations, especially in patients seeking a quick and less invasive recovery.
