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穿皮内镜腰椎间盘切除术在复发的腰椎间盘的使用:一个系统的审查和元分析

Saiganesh Ravikumar¹, Aaron Bloschichak², Sanjeev Kumar³

¹Department of Anesthesiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA.

Journal of spine surgery (Hong Kong)

|April 17, 2025

概括

穿皮内镜腰椎间盘切除术 (PELD) 有效治疗椎间盘 (LDH),显示显著的疼痛减轻和功能改善. 临床判断引导选择PELD而不是其他最少侵入性的选择,以获得最佳的患者结果.

科学领域:

最少侵入性的脊柱手术
神经外科神经外科
整形外科手术整形外科手术

背景情况:

穿皮内镜腰椎间盘切除术 (PELD) 是对腰椎间盘 (LDH) 的一种公认的治疗方法.
在PELD后的复发率在5-15%之间,关于管理这些复发病例的文献有限.
与其他最小侵入性技术相比,PELD对复发性LDH的疗效需要进一步研究.

研究的目的:

为了评估PELD对于复发的腰椎间盘的可用性.
为了比较PELD与复发性LDH的替代最小侵入性外科选择.
综合目前关于PELD在治疗复发性LDH的有效性和安全性的证据.

主要方法:

在PubMed,EMBASE和Web of Science进行了系统的文献搜索.
包含的研究集中在复发性LDH的PELD上,不包括那些有不到10名患者或仅发表摘要的研究.
考虑了跨甲状腺 (TF) 和介甲状腺 (IL) PELD 方法,并进行了偏差风险评估.

主要成果:

分析了20项涉及1,162名患者和1,165个磁盘的研究.
在背部疼痛 (5.24分) 和腿部疼痛 (5.26分) 的视觉模拟尺度 (VAS) 和奥斯威斯特残疾指数 (ODI) (20.88单位) 中观察到显著改善.
综合并发症率较低,复发率为5.70%;元分析显示,对于复发的LDH,PELD,微切除术或融合之间没有优越的方法.

结论:

PELD证明了在治疗复发性腰椎间盘的安全性和有效性.
该研究强调了基于临床判断的个性化治疗决策的必要性.
进一步的研究可能会根据特定的患者因素来澄清LDH复发的最佳外科手术方式.

关键词:

最少侵入性的脊柱手术脊柱内镜手术是指脊柱内镜手术.椎间盘的复发复发最少入侵的横腰间体内融合 (MIS-TLIF)穿皮内镜腰椎间盘切除术 (PELD)

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