单节段腰椎管狭窄症手术的临床评价：系统评价和贝叶斯网络荟萃分析,Orthopaedic Surgery

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单节段腰椎管狭窄症手术的临床评价：系统评价和贝叶斯网络荟萃分析
Orthopaedic Surgery ( IF 1.8 ) Pub Date : 2022-05-18 , DOI: 10.1111/os.13269
Zeyan Liang ₁ , Xiongjie Xu ₁ , Xinyao Chen ₁ , Yuandong Zhuang ₁ , Rui Wang ₁ , Chunmei Chen ₁

Affiliation

为了比较不同手术方式对单节段腰椎管狭窄症（LSS）患者的疗效和安全性，本研究进行了贝叶斯网络荟萃分析（NMA）。从 PubMed、Embase 和 Cochrane 对照试验注册库中检索了截至 2021 年 2 月报告手术后 2 年结果的随机对照试验 (RCT)。符合条件的 RCT 至少包含以下两种手术程序，通过双侧减压单侧入路 (BDUL)、传统椎板切除术 (CL) 减压、融合减压 (DF)、内窥镜减压 (ED)、仅棘突间装置 (IPD)、椎板间稳定减压 (DILS)、腰椎突减压-根据纳入和排除标准筛选后，将包括劈裂椎板切除术（LSPSL）和微创肾小管减压术（MTD）。主要结果是 Oswestry 残疾指数 (ODI)。纳入了 20 项符合条件的 RCT，共有 2201 名患者入组。NMA 显示，与 CL 和 DF 相比，以下外科手术排名第一（累积排名下的表面）： DILS 用于 ODI（SUCRA 87.8%）；LSPSL 治疗背痛（95%）；和 MTD 治疗腿部疼痛（95.6%）。MTD 在大多数结果中名列前三名。根据推荐分级评估、开发和评估标准，综合证据的质量较低。DILS、LSPSL、MTD、IPD 和 ED 是单节段 LSS 患者最有效的程序。由于结合了疗效和安全性，MTD 可能是治疗单节段 LSS 最有希望的常规手术选择。

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Clinical Evaluation of Surgery for Single-Segment Lumbar Spinal Stenosis: A Systematic Review and Bayesian Network Meta-Analysis

To compare the efficacy and safety of different surgical procedures for patients with single-segment lumbar spinal stenosis (LSS), Bayesian network meta-analysis (NMA) was conducted in this study. Randomized controlled trials (RCTs) which reported 2 years' results after surgery were searched from PubMed, Embase, and Cochrane Register of Controlled Trials up to February 2021. Eligible RCTs that contained at least two of the following surgical procedures, bilateral decompression via the unilateral approach (BDUL), decompression with conventional laminectomy (CL), decompression with fusion (DF), endoscopic decompression (ED), interspinous process devices only (IPDs), decompression with interlaminar stabilization (DILS), decompression with lumbar spinal process-splitting laminectomy (LSPSL), and minimally invasive tubular decompression (MTD), would be included after screening based on the inclusion and exclusion criteria. The primary outcome was Oswestry Disability Index (ODI). Twenty eligible RCTs were included, with a total of 2201 patients enrolled. The NMA showed that the following surgical procedures ranked first (surface under the cumulative ranking) when compared with CL and DF: DILS for ODI (SUCRA 87.8%); LSPSL for back pain (95%); and MTD for leg pain (95.6%). MTD ranked among the top three surgical procedures for most outcomes. The quality of the synthesized evidence was low according to the Grading of Recommendations Assessment, Development, and Evaluation criteria. DILS, LSPSL, MTD, IPDs, and ED are the most effective procedures for patients with single-segment LSS. Because of combining efficacy and safety, MTD may be the most promising routine surgical option for treating single-segment LSS.

更新日期：2022-05-18

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