超越显微镜:内断层切除术是腰椎间盘的下一个黄金标准吗?
Borriwat Santipas1,2,3, Jin Sung Kim2, Korawish Mekariya1
1Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Neurospine
|February 10, 2026
概括
内镜断层切除术 (ED) 与微断层切除术 (MD) 相比,提供更短的住院时间和更好的腰椎间盘的短期疼痛缓解. 然而,转膜内镜腰椎切除术的更高复发率限制了它的优越性.
科学领域:
- 神经外科 神经外科
- 最少侵入性的脊柱手术
- 基于证据的医学基于证据的医学.
背景情况:
- 微分隔膜切除术 (MD) 是腰椎间盘的既定标准.
- 内镜断层切除 (ED) 技术正在成为替代方案.
- 对临床决策而言,比较疗效数据至关重要.
研究的目的:
- 系统地比较内断层切除术 (ED) 与小断层切除术 (MD) 对于腰椎间盘.
- 为了评估患者报告的结果,外科手术期间的参数和并发症.
- 为了确定ED是否可以取代MD作为黄金标准治疗.
主要方法:
- 按照PRISMA指南进行系统审查和元分析.
- 搜索了主要数据库 (PubMed,Embase,Scopus,Web of Science) 的RCT和前性队列研究 (2000年1月至2025年6月).
- 分析结果包括ODI,VAS,手术时间,住院时间,并发症和复发,并根据ED亚型 (TELD,IELD,UBE) 进行亚组分析.
主要成果:
- 包括17项研究 (n=3,115);ED显著减少住院时间 (-2.43天) 和改善短期ODI.
- 在ED和MD之间,在操作时间或长期VAS/ODI得分上没有显著差异.
- ED显示伤口并发症较少,但TELD的复发风险较高 (OR ~2.0);观察到高异质性和有限的长期数据 (>2年).
结论:
- 内镜断层切除术提供了外科手术期间的好处,效果与微断层切除术相当.
- 变形膜内镜腰椎切除术的更高的复发风险可以防止ED超过MD.
- 层间内镜腰椎切除术和单侧双门内镜是有希望的,但MD仍然是基准;需要长期的RCT.
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