不同手术方式治疗腰椎间盘突出症的网状Meta分析

doi:10.3969/j.issn.2095-4344.2797

中国组织工程研究 ›› 2020, Vol. 24 ›› Issue (27): 4398-4405.doi: 10.3969/j.issn.2095-4344.2797

• 骨与关节循证医学 evidence-based medicine of the bone and joint • 上一篇下一篇

不同手术方式治疗腰椎间盘突出症的网状Meta分析

向熙1，司群超1，成伟益2，曹平1，郑金鹏1，胡冰1

1武汉科技大学附属天佑医院骨科，湖北省武汉市 430000；2湖北省妇幼保健院，湖北省武汉市 430000

收稿日期:2019-12-24 修回日期:2019-12-27 接受日期:2020-01-22 出版日期:2020-09-28 发布日期:2020-09-10
通讯作者: 胡冰，主任医师、副教授，武汉科技大学附属天佑医院骨科，湖北省武汉市 430000
作者简介:向熙，男，1992年生，湖南省古丈县人，土家族，武汉科技大学在读硕士，主要从事骨科研究。

A network meta-analysis of different surgical methods in the treatment of lumbar disc herniation

Xiang Xi1, Si Qunchao1, Cheng Weiyi2, Cao Ping1, Zheng Jinpeng1, Hu Bing1

1Department of Orthopedics, Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan 430000, Hubei Province, China; 2Maternal and Child Health Care Hospital of Hubei Province, Wuhan 430000, Hubei Province, China

Received:2019-12-24 Revised:2019-12-27 Accepted:2020-01-22 Online:2020-09-28 Published:2020-09-10
Contact: Hu Bing, Chief physician, Associate professor, Department of Orthopedics, Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan 430000, Hubei Province, China
About author:Xiang Xi, Master candidate, Department of Orthopedics, Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan 430000, Hubei Province, China

摘要/Abstract

摘要：

文题释义：

网状Meta分析：Meta分析通常只能比较2个干预措施，面对多种干预措施时却束手无策。网状Meta分析方法提供了一种有效、安全的筛选多种干预措施的方法，其是基于多个研究分析2个以上干预措施之间间接比较结果或直接比较结果与间接比较结果的合并结果的Meta分析。

标准化均数差(SMD)：Meta分析会遇到相同指标而计量单位不同的情况，文中的疼痛评分为连续型资料，对于连续型资料的效应量可采用标准均数差表示，其不仅消除了绝对值大小的影响，还消除了度量衡对结果的影响。

背景：目前用于治疗腰椎间盘突出症的手术方式较多，治疗效果各有优势，虽然已有许多Meta分析比较两两手术方式的疗效，但缺乏几种手术方式疗效的比较。

目的：应用网状Meta分析方法比较不同手术方式治疗腰椎间盘突出症的差异。

方法：检索PubMed、Embase、Cochrane Library、Ovid和中国知网数据库，收集有关不同手术方式治疗腰椎间盘突出症的随机对照试验或回顾性研究。按预先制定的纳入排除标准进行筛选，并对纳入的随机对照试验进行质量评价，采用STATA 15.0软件进行数据分析。

结果与结论：共纳入42个研究，5 156例患者，涉及9种手术治疗方式，包括腰椎间盘置换术、腰椎间盘融合术、标准椎间盘切除术、椎间盘镜下髓核摘除术、显微镜下髓核摘除术、经皮内窥镜腰椎间盘切除术、化学溶核术、自动经皮腰椎间盘切除术和经皮激光椎间盘减压术。网状Meta分析显示(从优至劣)：①缓解腿痛疗效方面排序为经皮激光椎间盘减压术>椎间盘镜下髓核摘除术>经皮内窥镜腰椎间盘切除术>标准椎间盘切除术>显微镜下髓核摘除术>腰椎间盘融合术>腰椎间盘置换术，差异无显著性意义；②缓解腰痛疗效方面排序为腰椎间盘置换术>腰椎间盘融合术>椎间盘镜下髓核摘除术>经皮内窥镜腰椎间盘切除术>显微镜下髓核摘除术>经皮激光椎间盘减压术>标准椎间盘切除术，部分差异有显著性意义；③改善Oswestry功能障碍指数方面排序为椎间盘镜下髓核摘除术>经皮内窥镜腰椎间盘切除术>标准椎间盘切除术>显微镜下髓核摘除术>腰椎间盘置换术>腰椎间盘融合术，差异无显著性意义；④手术成功率方面排序为腰椎间盘置换术>腰椎间盘融合术>椎间盘镜下髓核摘除术>经皮内窥镜腰椎间盘切除术>标准椎间盘切除术>经皮激光椎间盘减压术>显微镜下髓核摘除术>化学溶核术>自动经皮腰椎间盘切除术，部分差异有显著性意义；⑤再次手术率方面排序为腰椎间盘置换术>腰椎间盘融合术>显微镜下髓核摘除术>椎间盘镜下髓核摘除术>标准椎间盘切除术>经皮内窥镜腰椎间盘切除术>经皮激光椎间盘减压术>化学溶核术>自动经皮腰椎间盘切除术，差异无显著性意义；⑥并发症发生率方面排序为经皮内窥镜腰椎间盘切除术>自动经皮腰椎间盘切除术>标准椎间盘切除术>显微镜下髓核摘除术>经皮激光椎间盘减压术>椎间盘镜下髓核摘除术>腰椎间盘置换术>腰椎间盘融合术>化学溶核术，部分差异有显著性意义。结果表明，椎间盘镜下髓核摘除术和经皮内窥镜腰椎间盘切除术在各方面具有较好的疗效，腰椎间盘置换术和腰椎融合术在手术成功率方面较好，化学溶核术在手术成功率、再手术率及并发症发生率方面疗效均较差，经皮自动椎间盘切除术在手术成功率及再手术率方面疗效较差。

ORCID: 0000-0001-6307-8532(向熙)

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 腰椎间盘突出症, 网状Meta分析, 手术治疗, 经皮内窥镜腰椎间盘切除术, 椎间盘镜下髓核摘除术, 显微镜下髓核摘除术, 腰椎间盘置换术, 腰椎间盘融合术

Abstract:

BACKGROUND: At present, there are many surgical methods for the treatment of lumbar disc herniation, and the therapeutic effects have their own advantages. Although there are many meta-analyses to compare the therapeutic effects of the two surgical methods, there is no comparison of the therapeutic effects of several surgical methods.

OBJECTIVE: To compare the differences of different surgical methods in the treatment of lumbar disc herniation by network meta-analysis.

METHODS: PubMed, Embase, Cochrane Library, Ovid and CNKI were searched, and randomized controlled trials or retrospective studies on different surgical methods for the treatment of lumbar disc herniation were collected. According to the inclusion and exclusion criteria established in advance, the quality of included randomized controlled trials was evaluated, and the data were analyzed by STATA 15.0 software.

RESULTS AND CONCLUSION: A total of 42 studies, 5 156 patients and 9 surgical treatments were included. Surgical treatments contain total disc replacement, lumbar disc fusion, standard open discectomy, microendoscopic discectomy, microdiscectomy, percutaneous endoscopic lumbar discectomy, chemonucleolysis, automatic percutaneous lumbar discectomy and percutaneous laser disc decompression. The results of network meta-analysis showed that (from best to worst): (1) There was no significant difference in leg pain relief, and the rank probability was percutaneous laser disc decompression > microendoscopic discectomy > percutaneous endoscopic lumbar discectomy > standard open discectomy > microdiscectomy > lumbar disc fusion > total disc replacement. (2) There was no significant difference in low back pain relief, and the rank probability was total disc replacement > lumbar disc fusion > microendoscopic discectomy > percutaneous endoscopic lumbar discectomy > microdiscectomy > percutaneous laser disc decompression > standard open discectomy. (3) There was no significant difference in Oswestry disability index scores, and the rank probability was microendoscopic discectomy > percutaneous endoscopic lumbar discectomy > standard open discectomy > microdiscectomy > total disc replacement > lumbar disc fusion. (4) There were some statistical differences in the success rate, and the rank probability was total disc replacement > lumbar disc fusion > microendoscopic discectomy > percutaneous endoscopic lumbar discectomy > standard open discectomy > percutaneous laser disc decompression > microdiscectomy > chemonucleolysis > automatic percutaneous lumbar discectomy. (5) There was no significant difference in reoperation rate, and the rank probability was total disc replacement > lumbar disc fusion > microdiscectomy > microendoscopic discectomy > standard open discectomy > percutaneous endoscopic lumbar discectomy > percutaneous laser disc decompression > chemonucleolysis > automatic percutaneous lumbar discectomy. (6) There were some statistical differences in incidence of complications, and the rank probability was percutaneous endoscopic lumbar discectomy > automatic percutaneous lumbar discectomy > standard open discectomy > microdiscectomy > percutaneous laser disc decompression > microendoscopic discectomy > total disc replacement > lumbar disc fusion > chemonucleolysis. Results suggested that microendoscopic discectomy and percutaneous endoscopic lumbar discectomy are effective in all aspects. Disc replacement and lumbar disc fusion are the best in success rate of operation. Chemonucleolysis is poor in success rate of operation, reoperation rate and complications rate. Percutaneous automatic discectomy is poor in success rate of operation and reoperation rate.

Key words: lumbar disc herniation, network meta-analysis, surgical treatment, percutaneous endoscopic lumbar discectomy, microendoscopic discectomy, microdiscectomy, total disc replacement, lumbar disc fusion

中图分类号:

向熙, 司群超, 成伟益, 曹平, 郑金鹏, 胡冰. 不同手术方式治疗腰椎间盘突出症的网状Meta分析[J]. 中国组织工程研究, 2020, 24(27): 4398-4405.

Xiang Xi, Si Qunchao, Cheng Weiyi, Cao Ping, Zheng Jinpeng, Hu Bing. A network meta-analysis of different surgical methods in the treatment of lumbar disc herniation[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(27): 4398-4405.

图/表（结果） 10

2.1 文献筛选流程及结果初检出相关文献1 268篇，经逐层筛选后，最终纳入符合标准的文献42篇^[4-45]，共5 156例患者。文献筛选流程及结果见图1。

2.2 纳入文献的基本特征及质量评价纳入的42个研究中8个为中文，34个为英文，其中1篇为3臂研究，其余均为双臂研究。纳入研究的一般资料见表1，不同手术方式的网状关系图见图2。纳入研究的偏倚风险评价结果见图3，纳入的文献中未告知随机分配方法、分配方案隐藏及盲法占有较高的比例。

2.3.1 腿痛目测类比评分纳入的42个研究中有22个报告了患者术后腿痛的随访目测类比评分^{[5，9，13-23，30-31，35，39-41，43-45]}。纳入患者2 668例，其中腰椎间盘置换术245例、椎间盘融合术271例、标准椎间盘切除术838例、椎间盘镜下髓核摘除术399例、显微镜下髓核摘除术291例、经皮内窥镜腰椎间盘切除术218例及经皮激光椎间盘减压术148例。各手术方式结果比较差异无显著性意义，见表2，在缓解腿痛疗效排序为经皮激光椎间盘减压术>椎间盘镜下髓核摘除术>经皮内窥镜腰椎间盘切除术>标准椎间盘切除术>显微镜下髓核摘除术>腰椎间盘融合术>腰椎间盘置换术。

2.3.2 腰痛目测类比评分纳入的42个研究中有23个报告了患者术后腰痛的随访目测类比评分^{[4-5，10，15-17，19-23，29-30，32，35，38-45]}。纳入患者2 719例，其中腰椎间盘置换术297例、椎间盘融合术612例、标准椎间盘切除术552例、椎间盘镜下髓核摘除术426例、显微镜下髓核摘除术291例、经皮内窥镜腰椎间盘切除术178例及经皮激光椎间盘减压术148例。各手术方式结果比较差异无显著性意义，见表3，其中标准椎间盘切除术vs.椎间盘融合术比较差异有显著性意义，缓解腰痛疗效排序为腰椎间盘置换术>腰椎间盘融合术>椎间盘镜下髓核摘除术>经皮内窥镜腰椎间盘切除术>显微镜下髓核摘除术>经皮激光椎间盘减压术>标准椎间盘切除术。

2.3.3 Oswestry功能障碍指数评分纳入的42个研究中有20个报告了患者术后随访的Oswestry功能障碍指数评分^{[4-5，7-10，13，17，19-23，35，38-42，44-45]}。纳入患者3 154例，其中腰椎间盘置换术957例、椎间盘融合术884例、标准椎间盘切除术558例、椎间盘镜下髓核摘除术426例、显微镜下髓核摘除术111例及经皮内窥镜腰椎间盘切除术218例。各手术方式结果比较差异无显著性意义，见表4，改善Oswestry功能障碍指数方面排序为椎间盘镜下髓核摘除术>经皮内窥镜腰椎间盘切除术>标准椎间盘切除术>显微镜下髓核摘除术>腰椎间盘置换术>腰椎间盘融合术。

2.3.4 手术成功率纳入的42个研究中有28个报告了患者术后随访的手术成功率^{[4-5，7-13，17-18，20，22，24-37，42]}。纳入患者3 259例，其中腰椎间盘置换术940例、椎间盘融合术480例、标准椎间盘切除术703例、椎间盘镜下髓核摘除术218例、显微镜下髓核摘除术233例、经皮内窥镜腰椎间盘切除术178例、经皮激光椎间盘减压术48例、化学溶核术359例及自动经皮腰椎间盘切除术100例。各手术方式结果比较部分差异有显著性意义，见表5，手术成功率方面排序为腰椎间盘置换术>腰椎间盘融合术>椎间盘镜下髓核摘除术>经皮内窥镜腰椎间盘切除术>标准椎间盘切除术>经皮激光椎间盘减压术>显微镜下髓核摘除术>化学溶核术>自动经皮腰椎间盘切除术。

2.3.5 再手术率纳入的42个研究中有29个报告了患者术后随访的再手术率^{[5-12，14-16，18-23，25-28，30，32-33，36-37，41，45]}。纳入患者4 461例，其中腰椎间盘置换术1 062例、椎间盘融合术801例、标准椎间盘切除术1 080例、椎间盘镜下髓核摘除术357例、显微镜下髓核摘除术381例、经皮内窥镜腰椎间盘切除术170例、经皮激光椎间盘减压术148例、化学溶核术362例及自动经皮腰椎间盘切除术100例。各手术方式结果比较差异无显著性意义，见表6，再次手术率方面排序为腰椎间盘置换术>腰椎间盘融合术>显微镜下髓核摘除术>椎间盘镜下髓核摘除术>标准椎间盘切除术>经皮内窥镜腰椎间盘切除术>经皮激光椎间盘减压术>化学溶核术>自动经皮腰椎间盘切除术。

2.3.6 并发症发生率纳入的42个研究中有29个报告了术后随访的并发症发生率^{[5，7-10，12-19，21-22，25-26，29-33，35-38，41，44-45]}。纳入患者4 153例，其中腰椎间盘置换术901例、椎间盘融合术762例、标准椎间盘切除术1 122例、椎间盘镜下髓核摘除术354例、显微镜下髓核摘除术260例、经皮内窥镜腰椎间盘切除术248例、经皮激光椎间盘减压术100例、化学溶核术337例及自动经皮腰椎间盘切除术69例。各手术方式结果比较部分差异有显著性意义，见表7，并发症发生率方面排序为经皮内窥镜腰椎间盘切除术>自动经皮腰椎间盘切除术>标准椎间盘切除术>显微镜下髓核摘除术>经皮激光椎间盘减压术>椎间盘镜下髓核摘除术>腰椎间盘置换术>腰椎间盘融合术>化学溶核术。

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[35] HUSSEIN M, ABDELDAYEM A, MATTAR MMM. Surgical technique and effectiveness of microendoscopic discectomy for large uncontained lumbar disc herniations: A prospective, randomized, controlled study with 8 years of follow-up.Eur Spine J.2014;23(9):1992-1999.

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[37] MURALIKUTTAN KP, HAMILTON A, KERNOHAN WG, et al. A prospective randomized trial of chemonucleolysis and conventional disc surgery in single level lumbar disc herniation.Spine (Phila Pa 1976).1992;17(4):381-387.

[38] 蒲小兵,周强,杨双石,等.MED与微创TLIF治疗伴Modic改变的腰椎间盘突出症的对比研究[J].中国骨科临床与基础研究杂志,2014,6(2):79-83.

[39] 温德勇.不同手术方式治疗腰椎间盘突出伴Modic改变的临床疗效研究[J].中国实用医药,2014,9(23):18-19.

[40] 马富海,吴小涛,洪鑫,等.不同术式治疗伴终板Modic改变的腰椎椎间盘突出症的疗效分析[J].脊柱外科杂志,2011,9(2):69-73.

[41] 贺宪,黄东生,梁安靖,等.椎体间融合术与单纯髓核摘除术治疗合并Modic Ⅱ型改变的单节段腰椎间盘突出症的疗效比较[J].中国脊柱脊髓杂志, 2014,24(11):1007-1012.

[42] 王灏.伴终板Modic改变腰椎间盘突出症术式选择及其对疗效的影响研究[J].长治医学院学报,2014,28(3):210-212.

[43] 杨耀琦,曹鹏,潘玉涛,等.伴终板改变的腰椎间盘突出症的手术方式选择[J].中华医学杂志,2009,89(27):1902-1906.

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引言

材料方法

1.1 文献检索策略通过计算机采用主题词与自由词检索相结合的方式检索 PubMed、Embase、Cochrane Library、Ovid和中国知网数据库。英文检索主题词为“lumbar disc herniation、disc replacement、chemonucleoolysis、fusion、standard open discectomy、microdiscectomy、microendoscopic discectomy、percutaneous endoscopic lumbar discectomy、automatic percutaneous lumbar discectomy、percutaneous laser disc decompression”，中文检索主题词为“腰椎间盘突出症、腰椎间盘置换术、化学溶核术、腰椎间盘融合术、标准椎间盘切除术、显微镜下髓核摘除术、椎间盘镜下髓核摘除术、经皮内窥镜腰椎间盘切除术、自动经皮腰椎间盘切除术、经皮激光椎间盘减压术”，应用运算符“AND”或“OR”对以上的主题词及自由词进行自由组合。检索时间为建库至2019-12-10，不限定语言。为获得较为全面的文献，部分文献通过已发表的Meta分析或系统评价获得。

1.2 纳入与排除标准

纳入标准：①研究类型：随机对照试验或回顾性病例对照研究；②研究对象：年龄≥18岁，且症状和影像学确诊为腰椎间盘突出症手术患者；③干预措施：手术方式为腰椎间盘置换术、腰椎间盘融合术、标准椎间盘切除术、椎间盘镜下髓核摘除术、显微镜下髓核摘除术、经皮内窥镜腰椎间盘切除术、化学溶核术、自动经皮腰椎间盘切除术和经皮激光椎间盘减压术；④结果测量指标：纳入的文献结局指标至少包含腿痛目测类比评分、腰痛目测类比评分、Oswestry功能障碍指数评分、手术成功率、再手术率、并发症发生率中的一种。将研究中报道手术疗效为“Excellent、good、better、优和良”视为手术成功。

排除标准：①综述、会议报告、摘要等文献；②研究为腰椎间盘突出症再次手术的文献；③结局指标中只包含“腿痛评分、腰痛评分或Oswestry功能障碍指数评分”，且无法提取从基线到随访结束数据的文献。

1.3 文献筛选与资料提取对检索到的文献由2名研究员根据纳入排除标准独立进行文献筛选。筛选过程为：①检索到的文献导入到Endnote X7文献管理软件，通过软件去除重复文献；②阅读每篇文献的题目和摘要，排除明显不符合纳入标准的不相关文献；③经初筛以后，针对可能符合纳入标准的文献对全文逐一阅读并分析，以确定是否合格；④确定最终纳入的文献，进入资料提取阶段。如遇分歧则通过讨论或提交第3方咨询解决。资料提取主要包括：作者、发表时间、国家、随访时间、干预措施、病例数、结局指标。

1.4 文献质量评价根据Cochrane协作网推荐的偏倚风险评估工具进行文献质量评价，评价内容包括：随机顺序产生、对随机方案的分配隐藏、对研究对象及干预施者采取盲法、结局指标数据的完整性、选择性报告结果、偏倚的其他来源。每项以“低偏倚风险”“不清楚偏倚风险”和“高偏倚风险”进行评价。质量评价由2位研究者独立进行并交叉核对，如遇分歧讨论解决。

1.5 统计学分析使用Review Manager 5.3对纳入文献进行质量评价，并绘制偏倚分析图。采用STATA 15.0软件Network编码对数据进行网状Meta分析，绘制网络证据图和完成网状Meta分析及结果排序。STATA 15.0软件分析后的结果以效应量及95%CI呈现。对于连续型资料，如腿痛评分、腰痛评分、Oswestry功能障碍指数评分，效应量用标准化均数差(SMD)及95%CI表示，SMD<0表明在缓解疼痛或改善Oswestry功能障碍指数功能障碍方面，一种手术方式可能比另一种差；SMD>0表明一种手术方式可能比另一种更有效；95%CI包含0代表差异无显著性意义。对于二分类资料，如手术成功率、再次手术率和并发症发生率，效应量用比值比(OR)及95%可信区间表示，OR<1，表示一种手术方式可能比另一种差；OR>1，表示一种手术方式可能比另一种有效；95%可信区间包含1代表差异无显著性意义。

讨论

此次网状Meta分析共纳入42篇文献，通过分析手术后随访的腿痛目测类比评分、腰痛目测类比评分、Oswestry功能障碍指数评分、手术成功率、再手术率及并发症发生率，比较了临床上常见的9种治疗腰椎间盘突出症的手术疗效，并给出了各种手术方式疗效的概率排序。网状Meta分析结果显示：9种手术方式在缓解腿痛、腰痛、Oswestry功能障碍指数改善情况及再手术率方面差异无显著性意义，在手术成功率与并发症方面部分差异有显著性意义。在缓解腿痛和Oswestry功能障碍指数评分方面，腰椎间盘置换术和腰椎融合术的疗效较差，但是在缓解腰痛、手术成功率和再手术率方面，腰椎间盘置换术和腰椎融合术却有较好的疗效。化学溶核术在手术成功率、再手术率及并发症方面均比较差；经皮自动椎间盘切除术在手术成功率及再手术率方面是最差。腰椎间盘置换术和腰椎融合术一方面解除了因髓核突出导致的机械压迫、代谢性炎症和椎间盘自身免疫反应，另一方面不会增加腰椎不稳引起的软组织性下腰痛^[46]。临床上常见的腰椎间盘微创手术，如椎间盘镜下髓核摘除术和经皮内窥镜腰椎间盘切除术，与其他手术方式相比在各方面具有较好的疗效，但这两种手术疗效无明显差异，这个结果与SHI等^[47]的Meta分析结果一致，但他们分析认为经皮内窥镜腰椎间盘切除术在切口长度、手术时间、出血量、住院时间要优于椎间盘镜下髓核摘除术。在手术成功率、再手术率和并发症发生率方面，腰椎间盘置换术排序均优于腰椎间盘融合术。ZIGLER等^[48]的Meta分析中得出相似的结论，在再手术率方面腰椎间盘置换术与腰椎间盘融合术差异无明显统计学意义。化学溶核术是通过化学的方法溶解吸收或分解髓核组织，使其不再压迫或刺激神经，实现局部的减压作用，从而达到治疗的效果，但是化学溶核术对于髓核组织的溶解速度减慢切不能精准地控制，导致其治疗效果不佳，并且有较高的复发率^[49]。

研究利用网状Meta分析方法量化比较了多种干预措施，但也有一定的局限性，主要表现在：①纳入文献的随访时间长短不一，短的为6个月，长的达8年，对手术疗效的评价有一定影响；②疗效指标中成功率及并发症不统一。成功率的评判有的是根据患者的自我感觉，有的则是根据MacNab标准评价。手术方式不同，导致的并发症也不尽相同；③研究没有分析手术切口长度、手术时间、手术出血量等评价微创手术的指标；④部分手术方式纳入的文献较少，以及缺乏直接比较，如自动经皮椎间盘切除术和经皮激光椎间盘减压术对网状Meta分析结果有一定影响。

综上所述，各种手术方式在腿痛目测类比评分、腰痛目测类比评分、Oswestry功能障碍指数评分及再手术率和手术并发症发生率方面差异无显著性意义，椎间盘镜下髓核摘除术和经皮内窥镜腰椎间盘切除术在各方面具有较好的疗效，腰椎间盘置换术和腰椎融合术在手术成功率方面较好，化学溶核术在手术成功率、再手术率及并发症发生率方面疗效均较差，经皮自动椎间盘切除术在手术成功率及再手术率方面疗效较差。进一步期待更多高质量、大样本、多中心的直接比较研究验证该结果。

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

不同手术方式治疗腰椎间盘突出症的网状Meta分析

A network meta-analysis of different surgical methods in the treatment of lumbar disc herniation

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