单侧双通道内镜腰椎融合术安全性的荟萃分析△

Safety of unilateral biportal endoscopic lumbar interbody fusion: a meta-analysis

摘要:

[目的] 系统评价单侧双通道内镜 （unilateral biportal endoscopic, UBE） 辅助腰椎融合术与传统腰椎融合手术的安全性。[方法] 检索 The Cochrane Library、PubMed、Embase、Web of Science、Clinical Trals.gov、CBM、CNKI、VIP 和万方数据库，收集所有 UBE 与传统腰椎融合手术的对照研究，检索时限均为建库至 2022 年 4 月 13 日，采用 RevMan5.3 软件进行荟萃分析，对数据不能合并者进行描述性定性分析。[结果]共纳入 9 篇文献，均为回顾性队列研究，其中高质量文献 7 篇，中等质量 2 篇。总共纳入患者 796 例，其中 UBE 组 365 例，传统组 431 例。荟萃分析结果显示：UBE 组和传统组的总并发症发生率 （OR=0.94，95%CI 0.57~1.53，P=0.800）、硬膜外血肿发生率（OR=1.16，95%CI 0.38~3.52，P=0.800）、硬脊膜撕裂发生率（OR= 1.80，95%CI 0.76~4.30，P=0.180）、感染发生率 （OR=0.35，95%CI 0.09~1.30，P=0.120） 差异均无统计学意义 （P＞0.05）。此外，一过性麻木发生率（OR=1.03，95%CI 0.22~4.84，P=0.970）、减压不全发生率（OR=0.97，95%CI 0.18~5.33，P=0.970）、翻修手术发生率（OR=0.78, 95%CI 0.17~3.61，P=0.750）、融合器沉降发生率（OR=0.86，95%CI 0.30~2.47，P=0.780）差异均无统计学意义（P＞0.05）。[结论]UBE 辅助腰椎融合术与传统腰椎融合手术具有同等的安全性。

Abstract:

[Objective] To systematically evaluate the safety of unilateral biportal endoscopic (UBE) lumbar interbody fusion versus con- ventional lumbar interbaody fusion surgery. [Methods] The Cochrane Library, PubMed, Embase, Web of Science, Clinical Trals.gov, CBM, CNKI, VIP and Wanfang Database were searched to collect all comparative studies on UBE and conventional lumbar interbody fusion sur- gery from the establishment of the database to April 13, 2022, and then RevMan5.3 software was used for meta-analysis, additionally de- scriptive qualitative analysis was performed for data that could not be combined. [Results] A total of 9 articles were enrolled into this study, all of which were retrospective cohort studies, including 7 high-quality articles and 2 medium-quality articles. A total of 796 patients were involved, including 365 in the UBE group and 431 in the conventional group. As results of meta-analysis, there were no significant differenc- es in terms of total complication rates (OR=0.94, 95%CI 0.57~1.53, P=0.800), the incidence of epidural hematoma (OR=1.16, 95%CI 0.38~ 3.52, P=0.800), incidence of dural tear (OR=1.80, 95%CI 0.76~4.30, P=0.180), and incidence of infection (OR=0.35, 95%CI 0.09~1.30, P= 0.120) perioperatively between the UBE and traditional groups. Furthermore, there were no significant differences in terms of incidence of transient numbness (OR=1.03, 95% CI 0.22~4.84, P=0.970), incidence of incomplete decompression (OR=0.97, 95% CI 0.18~5.33, P= 0.970) and incidence of revision surgery (OR=0.78, 95%CI 0.17~3.61, P=0.750), and incidence of cage subsidence (OR=0.86, 95%CI 0.30~ 2.47, P=0.780) between the two groups. [Conclusion] UBE lumbar interbody fusion is as safe as conventional lumbar interbody fusion sur- gery.