[1]王一,李冷鋾,王澜洁,等.中国人腰椎间盘突出后重吸收发生率的Meta分析[J].中医正骨,2021,33(01):27-33.
　WANG Yi,LI Lengtao,WANG Lanjie,et al.Incidence of spontaneous resorption of lumbar disc herniation in Chinese:a meta analysis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(01):27-33.
点击复制

中国人腰椎间盘突出后重吸收发生率的Meta分析()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期数:
2021年01期
页码:
27-33
栏目:
文献研究
出版日期:
2021-01-20

文章信息/Info

Title:
Incidence of spontaneous resorption of lumbar disc herniation in Chinese:a meta analysis
作者:
王一1; 李冷鋾2; 王澜洁1; 戴国钢1
(1.四川省骨科医院,四川 成都 610041; 2.成都体育学院运动医学与健康学院,四川 成都 610041)
Author(s):
WANG Yi1; LI Lengtao2; WANG Lanjie1; DAI Guogang1
1.Sichuan Orthopaedic Hospital,Chengdu 610041,Sichuan,China2.School of Sports Medicine and Health of Chengdu Sport University,Chengdu 610041,Sichuan,China
关键词:
腰椎;  椎间盘移位;  重吸收;  Meta分析;  系统评价
Keywords:
lumbar vertebrae;  intervertebral disc displacement;  spontaneous resorption;  meta-analysis;  systematic review
摘要:
目的:分析中国人腰椎间盘突出后重吸收的发生率。方法:计算机检索中国知网、万方数据库、维普网2010年1月至2020年5月收录的所有有关中国人腰椎间盘突出后突出的椎间盘组织体积变化的中文文献,并手工检索相关文献。筛选文献后提取随访患者总数、发生重吸收患者数量、研究类型、重吸收判断方法(定性判断或定量判断)等重要数据,使用随机效应模型进行Meta分析,并进行亚组分析、敏感性分析、Meta回归分析和发表偏倚分析。结果:共检索到2301篇文献,最终纳入20篇文献进行分析。20项研究共随访1214例患者,723例发生重吸收; 其中随机对照试验5项,前瞻性非随机对照试验11项,回顾性研究4项; 7项研究采用定量方法判断重吸收情况,13项研究采用定性方法判断重吸收情况。Meta分析结果显示,腰椎间盘突出后重吸收的发生率为54%[I2= 98%,P=0.000; 95%CI(0.36,0.72)]。亚组分析显示,随机对照试验、前瞻性非随机对照试验、回顾性研究的重吸收发生率比较,差异无统计学意义(Q=0.30,P=0.86); 采用定量和定性方法判断重吸收情况的研究,重吸收发生率比较,差异无统计学意义(Q=0.14,P=0.70)。通过逐个剔除纳入的研究进行敏感性分析,结果显示腰椎间盘突出后重吸收发生率在50%[95%CI(0.33,0.67)]至58%[95%CI(0.41,0.75)]之间,提示Meta分析结果稳定。Meta回归分析显示,研究类型(R2=0,P=0.820)和采用不同方法判断重吸收(R2=15.34%,P=0.740)均不是异质性来源。Egger’s test未检测到发表偏倚存在(P=0.130)。结论:中国人腰椎间盘突出后重吸收的发生率为54%,临床上在选择手术治疗前应充分考虑腰椎间盘突出后重吸收的可能性。
Abstract:
To analyze the incidence of spontaneous resorption of lumbar disc herniation(LDH)in Chinese.Methods:All the Chinese articles about volume change of protrusion in Chinese LDH patients included from January 2010 to May 2020 were retrieved from China national knowledge internet,WanFang Database and VIP Database through computer.Meanwhile,all the relevant articles were manual retrieved.The information about total number of patients with follow-up,number of patients with spontaneous resorption of LDH,research type and qualitative and quantitative judgment method of spontaneous resorption were extracted from the articles,and Meta-analysis including subgroup analysis,sensitivity analysis,Meta regression analysis and publication bias analysis were conducted by using random effect model(REM).Results:Two thousand three hundred and one articles were searched out.After screening,20 articles(1214 patients with follow-up and 723 patients with spontaneous resorption of LDH)were included in the final analysis,including 5 randomized controlled trial(RCT)articles,11 prospective non-RCT articles and 4 retrospective trial articles.The spontaneous resorption was judged by quantitative method in 7 articles and qualitative method in 13 articles.The results of Meta-analysis demonstrated that the incidence rate of spontaneous resorption of LDH was 54%(I2=98%,P=0.000; 95%CI(0.36,0.72)).The results of subgroup analysis demonstrated that there was no statistical difference in the incidence rate of spontaneous resorption between RCT,prospective non-RCT and retrospective trial(Q=0.30,P=0.86)and between quantitative study and qualitative study(Q=0.14,P=0.70).The sensitivity analysis was performed through excluding the included articles in turn,and the results showed that the incidence rate of spontaneous resorption of LDH was between 50%(95%CI(0.33,0.67))and 58%(95%CI(0.41,0.75)),which suggested that the results of Meta analysis were stable.The results of Meta regression analysis demonstrated that both research type(R2=0,P=0.820)and judgment method(R2=15.34%,P=0.740)of spontaneous resorption were not the sources of heterogeneity.No publication bias was found by Egger’s test(P=0.130).Conclusion:The incidence rate of spontaneous resorption of LDH is 54% in Chinese.The possibility of spontaneous resorption of LDH should be fully considered before the surgical treatment in clinic.

参考文献/References:

[1] STAFFORD M,PENG P,HILL D A.Sciatica:a review of history,epidemiology,pathogenesis,and the role of epidural steroid injection in management[J].Br J Anaesth,2007,99(4):461-473.
[2] RAMASWAMI R,GHOGAWALA Z,WEINSTEIN J N.Management of sciatica[J].N Engl J Med,2017,376(12):1175-1177.
[3] SHRIVER M F,XIE J J,TYE E Y,et al.Lumbar microdiscectomy complication rates:a systematic review and meta-analysis[J].Neurosurg Focus,2015,39(4):E6.
[4] PEUL W C,VAN HOUWELINGEN H C,VAN DEN HOUT W B,et al.Surgery versus prolonged conservative treatment for sciatica[J].N Engl J Med,2007,356(22):2245-2256.
[5] PEUL W C,VAN DEN HOUT W B,BRAND R,et al.Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation:two year results of a randomised controlled trial[J].BMJ,2008,336(7657):1355-1358.
[6] WEINSTEIN J N,LURIE J D,TOSTESON T D,et al.Surgical vs nonoperative treatment for lumbar disk herniation:the spine patient outcomes research trial(SPORT)observational cohort[J].JAMA,2006,296(20):2451-2459.
[7] GUINTO F C Jr,HASHIM H,STUMER M,et al.CT demonstration of disk regression after conservative therapy[J].AJNR Am J Neuroradiol,1984,5(5):632-633.
[8] KREINER D S,HWANG S W,EASA J E,et al.An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy[J].Spine J,2014,14(1):180-191.
[9] 中华医学会骨科学分会脊柱外科学组,中华医学会骨科学分会骨科康复学组.腰椎间盘突出症诊疗指南[J].中华骨科杂志,2020,40(8):477-487.
[10] 刘建兴,张晓阳,徐俊.腰椎间盘突出自然演变的MRI观察[J].广东医学,2010,31(5):576-577.
[11] 郑寿鹏,尼哈提.鹿瓜多肽与甲钴胺联合治疗腰椎间盘突出症的临床观察[J].中国医药,2010,5(2):160-161.
[12] 葛恒清.针刀治疗对促进腰椎间盘突出后自然吸收现象的临床观察[J].世界中医药,2011,6(6):506-507.
[13] 孟彩云.腰椎间盘突出后自然吸收(针刀疗法)的疗效观察及护理分析[J].中国中医药现代远程教育,2011,16(16):42-43.
[14] 俞鹏飞,姜宏,刘锦涛.腰椎间盘突出与Modic改变相关性的研究——附95例临床观察[J].颈腰痛杂志,2011,32(6):416-419.
[15] 韩松,姜宏,俞鹏飞.消髓化核汤治疗青少年腰椎间盘突出症临床研究——附23例临床小结[J].中国中医骨伤科杂志,2012,20(10):35-37.
[16] 冯伟,冯天有,毕永民,等.借助3D-MRI扫描探讨脊柱(定点)旋转复位法治疗腰椎间盘突出症的临床研究[J].中国骨伤,2013,26(6):476-480.
[17] 戴国钢,刘剑伟,楚福明,等.破碎型腰椎间盘突出的诊治分析[J].四川医学,2014,35(10):1281-1284.
[18] 韩松,姜宏,孟祥奇,等.益气逐瘀利水方治疗青少年腰椎间盘突出症的疗效观察[J].颈腰痛杂志,2014,15(5):369-373.
[19] 俞鹏飞,姜宏,刘锦涛.破裂型腰椎间盘突出症非手术治疗后的转归[J].中国脊柱脊髓杂志,2015,25(2):109-114.
[20] 刘锦涛,俞鹏飞,姜宏.破裂型腰椎间盘突出症的保守治疗分析[J].颈腰痛杂志,2015,36(6):475-478. 中医正骨2021年1月第33卷第1期 J Trad Chin Orthop Trauma,2021,Vol.33,No.1(总033)(总034)中医正骨2021年1月第33卷第1期 J Trad Chin Orthop Trauma,2021,Vol.33,No.1
[21] 郑杨,汪丽佩,黄杰烽,等.口服补阳还五汤联合功能锻炼治疗后纵韧带破裂型腰椎间盘突出症[J].中医正骨,2016,28(7):49-52.
[22] 石有才,王彤.龙脊活络丸结合轻手法推拿治疗青少年腰椎间盘突出症临床研究[J].国际中医中药杂志,2016,38(10):891-894.
[23] 戴锋,俞鹏飞,徐坤林,等.中医药保守治疗破裂型腰椎间盘突出症42例[J].中国中医骨伤科杂志,2017,25(11):56-58.
[24] 王玉巧.持续牵引配合推拿手法治疗腰椎间盘突出症临床观察[J].内蒙古中医药,2017,36(14):118.
[25] 崔运能,杨伟超,方晓潮,等.腰椎间盘MR高信号区形态及信号强度纵向追踪[J].南方医科大学学报,2018,38(9):1135-1138.
[26] 孙博文,蔡亚楼,许建峰,等.烙灸联合腰背肌功能锻炼对后纵韧带破裂型腰椎间盘突出症患者髓核重吸收及复发率的影响[J].甘肃中医药大学学报,2019,36(1):60-63.
[27] 颜宾宏,牛乾,符致坚,等.丹鹿通督片治疗腰椎间盘突出症肾虚瘀阻证的疗效与机制[J].中国实验方剂学杂志,2019,25(22):66-71.
[28] 马智佳,姜宏,俞鹏飞,等.消髓化核汤保守治疗130例巨大型腰椎间盘突出症的疗效分析[J].中国骨伤,2019,32(3):239-243.
[29] 王丰,戴国钢,夏娇,等.腰椎矢状面平衡重塑对腰椎间盘破裂突出后自然吸收的影响[J].海南医学院学报,2020,26(13):1028-1032.
[30] HIGGINS J P,ALTMAN D G,G?TZSCHE P C,et al.The cochrane collaboration’s tool for assessing risk of bias in randomised trials[J].BMJ,2011,343:d5928.
[31] SLIM K,NINI E,FORESTIER D,et al.Methodological index for non-randomized studies(minors):development and validation of a new instrument[J].ANZ J Surg,2003,73(9):712-716.
[32] HIGGINS J P T,DEEKS J J,ALTMAN G,et al.Cochrane handbook for systematic reviews of interventions[M].New Jersey:John Wiley&Sons,2020:501.
[33] ZHONG M,LIU J T,JIANG H,et al.Incidence of spontaneous resorption of lumbar disc herniation:a Meta-Analysis[J].Pain Physician,2017,20(1):E45-E52.
[34] CHIU C C,CHUANG T Y,CHANG K H,et al.The probability of spontaneous regression of lumbar herniated disc:a systematic review[J].Clin Rehabil,2015,29(2):184-195.
[35] EL BARZOUHI A,VLEGGEERT-LANKAMP C L,LYCKLAMA à NIJEHOLT G J,et al.Magnetic resonance imaging in follow-up assessment of sciatica[J].N Engl J Med,2013,368(11):999-1007.

相似文献/References:

[1]吴青坡,孙国绍,王林杰.后路椎管减压联合腰椎椎弓根钉动态稳定装置内固定 治疗单节段腰椎退行性疾病[J].中医正骨,2015,27(10):42.
[2]李林军.应用膨胀式椎弓根螺钉内固定治疗合并骨质疏松的 胸腰椎退行性疾病[J].中医正骨,2015,27(08):49.
[3]孙广江,崔海舰.络病理论指导下应用独活寄生汤加减治疗腰椎间盘突出症[J].中医正骨,2015,27(12):37.
　SUN Guangjiang,CUI Haijian.Clinical study on oral application of Duhuo Jisheng Tang Jiajian(独活寄生汤加减)under the guidance of collaterals disease theory for treatment of lumbar disc herniation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(01):37.
[4]陈冠军,陈扬,庄汝杰.可灌注骨水泥椎弓根螺钉系统 在老年腰椎疾患手术中的应用[J].中医正骨,2015,27(02):40.
[5]万宏波,马海燕,蒋云霞,等.口服益气化瘀汤联合功能锻炼治疗腰椎退行性疾病 术后残留腰腿痛的临床研究[J].中医正骨,2015,27(06):1.
　WAN Hongbo,MA Haiyan,JIANG Yunxia,et al.Clinical study on oral application of Yiqi Huayu Tang(益气化瘀汤)combined with functional exercise for the treatment of postoperative residual lumbocrural pain in patients with lumbar degenerative disease[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(01):1.
[6]王世龙.腰椎椎管内外痛风石1例[J].中医正骨,2012,24(02):69.
[7]秦杰,李振宇.三法十式手法配合中药腰痹汤治疗腰椎间盘突出症[J].中医正骨,2011,23(02):71.
[8]颜 峰.椎间融合术配合中药外敷治疗退行性腰椎滑脱症[J].中医正骨,2016,28(01):38.
[9]喻秋萍,唐萌芽,王峥峰,等.身痛逐瘀汤治疗腰椎间盘突出症的系统评价[J].中医正骨,2016,28(06):24.
　YU Qiuping,TANG Mengya,WANG Zhengfeng,et al.Efficacy of Shentong Zhuyu Tang(身痛逐瘀汤)for treatment of lumbar disc herniation:a systematic review[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(01):24.
[10]董永强,何鑫东,张伟伟,等.经皮椎间孔镜髓核摘除术联合McKenzie疗法治疗腰椎间盘突出症的临床研究[J].中医正骨,2016,28(07):38.
　DONG Yongqiang,HE Xindong,ZHANG Weiwei,et al.Observation on the curative effect of fire-needle therapy for treatment of supraspinal and interspinal ligament injuries[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(01):38.
[11]刘彦璐,林耐球,李绍旦,等.正骨手法结合中药外敷治疗腰椎间盘突出症[J].中医正骨,2015,27(02):26.
[12]邵礼晖,潘浩.Coflex棘突间动态稳定系统治疗腰椎退变性疾病40例[J].中医正骨,2015,27(02):37.
[13]郭新军,朱卉敏,王衡,等.一次性纤维环缝合器在腰椎间盘突出症髓核摘除术中的应用[J].中医正骨,2015,27(03):59.
[14]林斌,黎秋生,何勇,等.椎弓根螺钉单侧固定与双侧固定治疗腰椎间盘突出症 对邻近节段退变的影响[J].中医正骨,2015,27(01):16.
　LIN Bin,LI Qiusheng,HE Yong,et al.Effect of unilateral versus bilateral fixation with pedicle screws on adjacent segment degeneration in patients with lumbar disc herniation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(01):16.
[15]贾龙,张华.“治未病”思想指导下腰椎间盘突出症的辨证防治[J].中医正骨,2017,29(01):36.
[16]聂富祥,贺海怿,朱文辉,等.一次性可扩张通道下微创经椎间孔入路腰椎间融合术治疗单节段腰椎退行性疾病[J].中医正骨,2017,29(05):34.
[17]宋仁谦,周英杰,赵刚.经皮可灌注骨水泥椎弓根螺钉固定治疗合并严重骨质疏松症的腰椎退行性疾病[J].中医正骨,2017,29(05):37.
[18]张史飞,任绍东,屠永刚,等.椎弓根螺钉双皮质固定治疗合并骨质疏松的腰椎不稳症[J].中医正骨,2017,29(09):73.
[19]邓罗义,孙红,宁旭.神经根沉降征及其在腰椎退行性疾病诊断中的应用价值[J].中医正骨,2018,30(08):50.
[20]李智斐,李嘉琅,张翼升,等.医用臭氧治疗腰椎间盘突出症的作用机制及应用进展[J].中医正骨,2018,30(10):59.

备注/Memo

备注/Memo:
基金项目:四川省卫生和计划生育委员会科研课题(16PJ389); 中国民族医药学会科研项目(2017KYXM-Z172-40); 四川省医学会骨科(尚安通)专项科研课题(2019SAT06); 四川省骨科医院院内课题(2017-4)
通讯作者:戴国钢 E-mail:guogang_dai@hotmail.com
更新日期/Last Update: 2021-01-20