摘要
背景:颈前路减压植骨融合是目前治疗退变性颈椎病手术方案中的"金标准"。但是,随着颈前路减压植骨融合技术使用的增加和随访资料的不断丰富,一些不良结果开始暴露出来。近20年来,人工颈椎间盘置换技术在国外和国内逐步推广并广泛应用于临床,文献报道治疗效果令人满意。目的:系统评价颈椎间盘置换与传统的颈前路减压植骨融合治疗退变性颈椎病治疗效果的差异。方法:计算机检索Medline(1966/2009-06),荷兰医学文摘(EMbase1966/2009-06),Cochrane图书馆(2009年第2期)、Cochrane协作网背痛专业试验数据库、中国生物医学文献数据库(CBM截止2009-06),CNKI(截止2009-06),手工检索中文文献,收集颈椎间盘置换与颈前路减压植骨融合比较治疗退变性颈椎病的随机、半随机对照试验,进行严格的质量评价,利用RevMan4.2.2软件对纳入研究结果进行Meta分析。结果与结论:共纳入15个研究,Meta分析结果显示:颈椎间盘置换与颈前路减压植骨融合术比较平均出血量、手术时间、住院时间及术后并发症差异无显著性意义;术后2年再手术率颈椎间盘置换组低于颈前路减压植骨融合组;手术满意率两组差异无显著性意义;颈椎间盘置换组术后颈部功能异常指数较颈前路减压植骨融合组明显改善,术后SF-36评分改善显著优于颈前路减压植骨融合组;术后手术节段运动幅度颈椎间盘置换组显著大于颈前路减压植骨融合组,术后邻近节段运动范围颈前路减压植骨融合组明显较颈椎间盘置换组增大。但上述结果可能存在各种偏倚,因此需要更多高质量的临床随机对照试验来得出更为可靠的结论。
BACKGROUND： Anterior cervical discectomy and fusion （ACDF） is a gold standard to treat degenerative cervical syndrome. However, with the increasing application and follow-up data of ACDF, its adverse effects have been shown. In the past 20 years, artificial cervical disc replacement has been widely used in clinic, and the therapeutic effect is favorable. OBJECTIVE： To assess the effect of cervical disc replacement versus ACDF for cervical radiculopathy or myelopathy. METHODS： A computer-based online search of Medline （1966/2009-06）, Embase （1966/2009-06）, CBM （2009-06） and CNKI （2009-06）, as well as Cochrane Back Group, and Cochrane library were performed to collect randomized controlled trials of cervical disc replacement versus ACDF. Data were evaluated by RevMan4.2.2 for Meta analysis. RESULTS AND CONCLUSION： A total of 15 studies were included. Meta-analysis indicates that no differences were found in the mean operation time, mean blood loss, mean hospital stay, satisfaction rate, and complication between two groups; the reoperation rate of the disc replacement group was lower than ACDF group in two years postoperation; disc replacement group was more efficient in improving cervical function indexes than ACDF group, and the postoperative SF-36 scores were significantly more than ACDF group. Moreover, postoperative motion range of affected segment was significantly greater in the disc replacement group than the ACDF, and the motion rage of adjacent segment was significantly increased in patients underwent ACDF compared with disc replacement treatment. However, there may be bias, more randomized controlled trials are required.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2010年第4期615-620,共6页
Journal of Clinical Rehabilitative Tissue Engineering Research
