摘要
[目的]系统评价椎管成形术与前路手术治疗多节段脊髓型颈椎病的疗效与安全性。[方法]计算机检索Cochrane图书馆(2013年第5期)、PubMed(1966年~2013年5月)、OVID(1950年~2013年5月)、EMbase(1966年~2013年5月)、中国生物医学文献数据库(1978年~2013年5月)、万方数据库(1998年~2013年5月)、中国期刊全文数据库(1999年~2013年5月),手工检索《中华外科杂志》等5种相关杂志,收集椎管成形术与前路手术治疗多节段脊髓型颈椎病疗效与安全性的随机或半随机对照试验,由两名评价者按纳入与排除标准选择试验、提取资料和质量评价后,采用RevMan 5.2软件进行Meta分析。[结果]最终纳入8个对照试验,共580例患者。Meta分析结果显示:椎管成形术与前路手术的术后并发症发生率[OR=0.25,95%CI(0.13,0.45),P<0.00001]、邻近节段退变发生率[OR=0.17,95%CI(0.04,0.68),P=0.01]、再手术率[OR=0.14,95%CI(0.05,0.45),P=0.000 8]、手术时间[WMD=-64.62,95%CI(-74.48,-54.75),P<0.000 01]和术中出血量[WMD=-192.71,95%CI(-224.77,-160.65),P<0.000 01]的差异有统计学意义;而两组术前JOA评分[WMD=-0.17,95%CI(-0.53,0.18),P=0.34]、术后JOA评分[WMD=-0.28,95%CI(-0.91,0.36),P=0.39]、神经功能改善率[WMD=-4.42,95%CI(-12.09,3.25),P=0.26]和颈椎活动度[WMD=-3.08,95%CI(-13.44,7.28),P=0.56]的差异无统计学意义。[结论]椎管成形术与前路手术治疗多节段脊髓型颈椎病,脊髓神经功能的改善无显著不同;但椎管成形术具有手术时间短,术中出血量少,术后并发症发生率、临近节段退变发生率和再手术率低等优点。
[ Objective] To assess the clinical effectiveness and safety of laminoplasty versus anterior approach for multilevel cervical spondylotic myelopathy. [ Methods] The following databases were searched： The Cochrane Library, PubMed, OV- ID, EEM base, CBM, WanFang Data, CNKI. Five relevant journals were manually searched for randomized controlled trials or clinical controlled trials （CCTs） that investigated the clinical effectiveness and safety of laminoplasty and anterior approach for multilevel cervical spondylotic myelopathy. Two reviewers independently screened the literature according to inclusion and exclu- sion criteria, extracted the data, and assessed the methodological quality of included studies. Meta - analysis was performed by using RevMan 5.2 software. [ Results ] Eight CCTs, involving 580 patients, were included. No significant differences were found between laminoplasty and anterior approach with respect to complications （odds ratio [ OR] 0. 25, 95% confidence inter- val [CI] 0. 13 -0.45, P〈0.000 01）, adjacent segment degeneration （OR0. 17, 95% CI 0.04 ~0.68, P=0.01）, second- ary surgical procedures （OR 0. 14, 95% CI O. 05 -0. 45, P = 0. 000 8 ）, operation time, （weighted mean difference [ WMDJ -64. 62, 95% CI -74. 48 ~ -54.75, P 〈0. 000 01） and amount of intraoperative bleeding （WMD - 192. 71, 95% CI - 224. 77 ~ - 160. 65, P 〈 0. 000 01 ） . In addition, there were no significant differences in preoperative JOA scores （WMD - 0. 17, 95% CI -0. 53 -0. 18, P =0. 34） , postoperative JOA scores （WMD -0. 28, 95% CI -0. 91 ~0. 36, P =0. 39）,recovery rate （WMD -4.42, 95% CI - 12.09 -3.25, P= 0. 26） and cervical range of motion （WMD -3.08, 95% CI - 13.44 -7.28, P = 0. 56） . [ Conclusion3 There were no significant differences between laminoplasty and anterior approach for muhilevel cervical spondylotic myelopathy in the recovery of neur^fmaefion of the spinal cord. However, laminoplasty showed shorter operation time, less intraoperative bleeding, fewer adjacent segment degenerations, fewer complications, and fewer see- ondary surgical procedures.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2014年第5期401-407,共7页
Orthopedic Journal of China
关键词
脊髓型颈椎病
椎管成形术
前路手术
META分析
系统评价
cervical spondylotie myelopathy, laminoplasty, anterior approach, meta - analysis, systematic review
