| Objective:1.To investigate the clinical efficacy of percutaneous spinal endoscopy in the treatment of patients with lumbar disc herniation and how to reduce the learning curve.2.Comparison of percutaneous endoscopic discectomy(PELD)and posterior open microdiscectomy(OLMD)in the treatment of lumbar disc herniation.Method:1.A total of 116 patients with single-segment lumbar disc herniation who underwent percutaneous endoscopic discectomy from the first hospital affiliated to Xiamen University from June 2015 to May 2017 were followed up prospectively.There are 64 males and 52 females,averaged 34.8(15-61)years old,recording the operation time,the amount of bleeding and the postoperative hospital stay.Follow-up was performed at 1 week,3 months,6 months,and 1 year after surgery,and the clinical effect was evaluated by the VAS score of the limb pain,the Oswestry Disability Index(ODI)and the modified MacNab criteria.And perform statistical analysis.2.A systematic literature search was conducted on the experimental study of the above two procedures in the treatment of lumbar disc herniation using PubMed,Cochrane Library,EMBASE and MEDLINE.Screening randomized trials and observational studies that met the inclusion criteria.Two reviewers extracted data separately and assessed the risk of bias.All statistical analyses were performed using Review Manager 5.3.Outcome:1.The average operation time of percutaneous endoscopic discectomy was 39.2±10.3min,the bleeding volume was 8.4±2.7ml,the postoperative hospital stay was 1.5±0.8d,and the complication rate was 2.6%.The final follow-up rate was 96.55%,and the recurrence rate was 1.8%.The VAS score of the affected limb was statistically different(P<0.05)from 1 week(2.9±1.8),3 mons(2.0±1.1),6 mons(1.7±0.8),and 12 mons(1.2±1.2)compared with preoperative(7.8±1.3).The difference of lumbar modified ODI score 1 week after surgery(16.2±1.7),3 mons(15.5±1.9),6 mons(11.8±2.3),12 mons(9.5±2.4)compared with preoperative(37.6±10.2)was statistically significant(P<0.05).The data are normally distributed.The last follow-up results were excellent in 64 cases,good in 37 cases,and fair in 9 cases based on the modified MacNab criteria.The excellent and good rate was 90.2%.2.The Meta-analysis included a total of 11 literature studies,3 randomized controlled trials,and 8 non-randomized controlled trials,all of which were assessed to be moderate to high quality.A total of 1826 patients were involved in the study,and 1763 patients were obtained at the last follow-up(follow-up rate 96.5%).Among them,744 patients in the PELD treatment group and 1082 patients in the OLMD treatment group.In the clinical application of single segmental lumbar disc herniation,both are safe and effective.At the time of surgery(WMD=-9.42,95% CI:-19.07~0.23,I 2=94%,P=0.06),complication rate(OR=1.23,95% CI: 0.74~2.07,I 2=43%,P=0.43),recurrence rate(OR=1.09,95% CI: 0.68~ 1.75,P=0.72),low back pain VAS score(preoperative subgroup: WMD=0.28,95% CI:-0.34~0.91,P= 0.37,postoperative 12 months subgroup: WMD=-0.13,95% CI:-0.52~0.26,P=0.51,postoperative 24 months subgroup: WMD=-1.16,95%CI:-2.33~0.01,P= 0.05),leg pain VAS score(preoperative subgroup: WMD = 0.01,95% CI:-1.87~ 1.89,P = 0.99,postoperative December subgroup: WMD =-0.13,95% CI:-0.52 ~ 0.26,P=0.51,postoperative 24 months postoperative group: WMD=-2.70,95% CI:-9.96~4.55,P=0.47),ODI index(preoperative subgroup: WMD=0.01,95% CI:-1.87~ 1.89,P=0.99,postoperative 12 months subgroup: WMD=-0.13,95% CI:-0.52~0.26,P=0.51,postoperative 24 months subgroup: WMD=-2.70,95%CI:-9.96~ 4.55,P=0.47)and MacNab standard excellent rate(OR=1.14,95% CI: 0.84~1.53,I 2=0%,P=0.40).There was no significant difference between PELD treatment group and OLMD treatment group.During hospitalization(WMD=-4.09,95% CI:-5.79~-2.39,I 2=95%,P<0.00001)PELD is more advantageous in terms of working time(WMD=-2.21,95% CI:-2.54~-11.8,I 2=28%,P<0.00001),but the OLMD group has a lower reoperation rate(OR=1.77,95)%CI: 1.19~2.64,I 2=0%,P=0.005).The systematic review showed that the PELD incision was smaller and the amount of bleeding was less,which was helpful to prevent the loss of intervertebral space and the narrowing of the intervertebral foramen.There was a certain learning curve;the amount of OLMD radiation was less;the quality of life and the signal of the intervertebral disc were changed after surgery.There was no statistically significant difference in endplate Modic classification and facet joint degeneration.Conclusion:1.Percutaneous spinal endoscopic discectomy for the treatment of simple lumbar disc herniation is safe and effective,with the advantages of small trauma and quick recovery,and has clinical promotion value.2.PELD technology hospitalization time and re-work time is shorter,less minimally invasive,less bleeding,better in preventing height loss of intervertebral space and narrowing of intervertebral foramen,but need to overcome a certain learning curve;OLMD technology reoperation rate Lower and less radiation;there was no statistically significant difference between the PELD group and the OLMD group in terms of operative time,complication rate,recurrence rate,VAS score of low back and leg pain,ODI index and MacNab standard.There was no statistically significant difference in postoperative quality of life,intervertebral disc signal changes,endplate Modic typing,and small articular degeneration.3.For single-segment simple lumbar disc herniation,whether PELD technology can replace OLMD technology as a "gold standard procedure" still requires more high-quality clinical evidence. |
PDF Full Text Request