Radiofrequency ablation combined with ozone in the treatment of lumbar disc herniation: a meta-analysis

doi:10.3969/j.issn.2095-4344.2014.13.022

Abstract

Abstract:

BACKGROUND: Support radiofrequency ablation combined with ozone provides novel idea for lumbar disc herniation. Their combination intervened with minimally invasive surgery can bring their advantages, but its therapeutic effect still lacks of evidences from evidence-based medicine.
OBJECTIVE: To evaluate the effectiveness and feasibility of radiofrequency ablation combined with ozone for lumbar disc herniation.
METHODS: Systematic and comprehensive database search was performed in PubMed, CENTRAL, SCI, EMBASE.com, Chinese Biomedical Literature Database, China National Knowledge Infrastructure and Wanfang database for literatures published from database establishment to June 22 2013. According to inclusion and exclusion criteria, randomized controlled trials on support radiofrequency ablation combined with ozone for lumbar disc herniation were collected. The risk of bias tool described in the Cochrane Handbook version 5.1.0 was used to assess the quality of each trial. Meta-analysis was performed using RevMan 5.2 software. RESULTS AND CONCLUSION: Totally 63 records were collected. A total of 8 randomized controlled trials
involving 662 patients met inclusion criteria. The results of meta-analysis showed between ozone alone, and at
1 week, 3 and 6 months after combined treatment, significant differences were detected in excellent and good rate [RR=0.36, 95%CI(0.21, 0.59); RR=0.24, 95%CI(0.14, 0.43); RR=0.41, 95%CI(0.24, 0.70)], effective rate [RR=0.31, 95%CI(0.12, 0.82); RR=0.28, 95%CI(0.09, 0.84); RR=0.22, 95%CI(0.06, 0.80)], and visual analogue scale score [MD=-1.06, 95%CI(-1.83, -0.28)]. Results indicated that radiofrequency ablation combined with ozone is effective and feasible for lumbar disc herniation, with the characteristics of fast recovery, pain relief, and good long-period therapeutic effects.

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

全文链接：

Key words: ablation techniques, ozone, intervertebral disk displacement, lumbar vertebrae, meta-analysis

CLC Number:

R318

Dou Yu-gui, Wang Wen-. Radiofrequency ablation combined with ozone in the treatment of lumbar disc herniation: a meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(13): 2096-2103.

Figures/Tables 6

2.2 质量评价根据根据Cochrane Handbook 5.1偏倚风险评估工具对纳入的8个研究进行质量评价，结果显示：多数研究(5/8)没有详实报道随机方法和分配隐藏方案，由于临床研究的特殊性，6篇(75%)研究没有对研究对象实施盲法，大部分(7/8)研究未明确报道失访、退出人数，及是否进行了意向性分析，只有少数研究(3/8)讨论了其他偏倚来源。图2为纳入文献的质量评价。 2.3 Meta分析结果 2.3.1 MacNab评价结果依据MacNab方法进行疗效评价，2个研究报告了治疗后1周的疗效评价[10，15]，其中优、差两级报告差异有显著性意义(P < 0.05)；3个研究报道了治疗后1个月的疗效评价[10-12]，其中良、可、差3级联合组和对照组差异无显著性意义(P > 0.05)；3个研究报告了治疗后3个月的疗效评价[10，14-15]，其中优、良两级差异无显著性意义(P > 0.05)，可、差两级实验组和对照组差异有显著性意义(P < 0.05)；3个研究报告了随访6个月后的疗效评价[13，15-16]，优、可、差两3级都具有显著性意义，而等级为良者两组差异无显著性意义(P=0.84)。表2为两组MacNab方法疗效评价结果比较。由于研究数量有限，未能进行漏斗图分析发表偏倚。 2.3.2 优良率分析纳入的8个研究均报道了射频热凝联合臭氧和单纯臭氧疗效的优、良、可、差分级，根据随访时间1周、1，3，6个月的不同，对各个报道进行分层分析，其中：2个研究报道了1周后的优良率[10,15]，各研究间不存在统计学异质性(P=0.30，I2=6%)，采用固定效应模型合并分析，Meta分析结果显示：两组间在治疗后1周的疗效差异有显著性意义[RR=0.41，95%CI(0.24，0.70)，P=0.001]，表明联合组较单纯臭氧组优良率更高，疗效更佳；3个研究对治疗1个月后的优良率进行了比较[10-12]，各研究间同质性较好(P=0.17，I2=44%)，采用固定效应模型合并数据，Meta分析结果显示：两组间在治疗1个月后的疗效差异无显著性意义[RR=0.72，95%CI(0.42，1.25)，P=0.24]，表明两组间优良率相同；3个研究报道了治疗后3个月的优良率[10, 14-15]，各研究间无统计学异质性(P=0.79，I2=0%)，采用固定效应"

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