摘要
背景:虽然近年来国内不少脊柱外科医师开始使用显微镜行颈前路减压手术,但显微镜的使用仍未在国内推广开来。因此有必要对显微镜辅助颈椎前路精细化减压与传统直视下颈椎前路减压治疗颈椎病的临床疗效进行系统评价和分析,为颈椎病治疗的临床决策提供证据支持。目的:系统评价显微镜辅助与传统直视下颈椎前路减压治疗颈椎病的临床疗效。方法:检索Medline、Embase、PubMed、Web of Science、中国生物医学文献数据库(CBM)、万方、维普以及中国知网等数据库自建库以来至2019年7月有关显微镜辅助与传统直视下行颈椎前路减压治疗颈椎病疗效对比的文献,由2名研究人员独立进行文献筛选。并对2组手术时间、术中出血量、术前及术后日本骨科协会评分、神经功能改善率、术前及术后目测类比评分、并发症发生率等指标进行比较。采用国际Cochrane协作网推荐的改良Jadad量表、改良纽卡斯尔-渥太华量表及MINORS量表对纳入研究的文献进行质量评价,采用Stata 12.0软件进行对相关结局指标进行Meta分析。结果与结论:①12篇研究符合纳入标准,共包括892例患者,其中显微辅助组438例,传统直视组454例;②显微辅助组与传统直视组患者的术前日本骨科协会评分[WMD=-0.100,95%CI(-0.459,0.259),P=0.585]、手术时间[WMD=6.852,95%CI(-0.446,14.149),P=0.066]、术前及术后目测类比评分[WMD=0.293,95%CI(-0.023,0.608),P=0.069;MWD=-0.718,95%CI(-1.495,0.059),P=0.070]相比,差异均无显著性意义;③与传统直视组相比,显微辅助组能显著提高患者的术后日本骨科协会评分[WMD=1.310,95%CI(0.621,1.998),P<0.001]和神经功能改善率[WMD=4.639,95%CI(0.294,8.984),P=0.036],并能显著减少术中出血量[WMD=-18.068,95%CI(-24.504,-11.632),P<0.001],降低并发症发生率[RR=1.068,95%CI(1.012,1.126),P=0.002];④提示与传统直视下手术相比,显微镜辅助下行颈椎前路减压治疗颈�
BACKGROUND:In China,although microscope-assisted anterior cervical decompression has been performed by many spine surgeons in recent years,the application of microscope still needs to be further promoted in China.Therefore,it is necessary to systematically evaluate and analyze the clinical efficacy of cervical spondylopathy by comparing patients under microscope-assisted anterior cervical approach to traditional anterior cervical approach.As a result,it can provide the evidence for clinical decision in these cervical spondylopathy patients.OBJECTIVE:To systematically evaluate the effect between microscope-assisted anterior cervical approach and traditional anterior cervical approach in cervical spondylopathy patients.METHODS:Databases such as Medline,Embase,PubMed,Web of science,CBM,Wangfang databases,VIP,and CNKI were searched from inception to July 2019 to find literature related to microscope-assisted anterior cervical approach and traditional anterior cervical approach in treatment of cervical spondylopathy.Two investigators evaluated the researches independently and compared the operative time,intraoperative blood loss,the preoperative and postoperative Japanese Orthopedic Association score,neurological success rate,the preoperative and the postoperative visual analogue scale score,and the complication rates between two groups.The quality of the included literature was evaluated by the modified Jadad scale,the modified Newcastle Ottawa score and the methodological index for non-randomized-studies.The correlative clinical outcome in inclusive research was analyzed systematically by using Stata 12.0 Software.RESULTS AND CONCLUSION:(1) Twelve studies were accorded with the inclusion criteria,containing 892 cases(438 cases in the microscope-assisted group,while 454 cases in the traditional group).(2) There were no significant differences in the preoperative Japanese Orthopedic Association score(WMD=-0.100,95%CI(-0.459,0.259),P=0.585),operative time(WMD=6.852,95%CI(-0.446,14.149),P=0.066),the preoperative and pos
作者
罗海涛
程祖珏
吕世刚
肖爵贤
何伟
黄凯
范阳华
祝新根
Luo Haitao;Cheng Zujue;Lu Shiga ng;Xiao Juexia n;He Wei;Huang Kai;Fan Yanghua;Zhu Xingen(Department of Neurosurgery,Second Affiliated Hospital of Nanchang University,Nanchang 330006,Jiangxi Provinee,China)
出处
《中国组织工程研究》
CAS
北大核心
2020年第9期1464-1470,共7页
Chinese Journal of Tissue Engineering Research
基金
江西省教育厅科学技术研究项目(60159),项目负责人:程祖珏
江西省卫生与计划生育管理委员会项目(20175224),项目负责人:程祖珏
江西省卫生与计划生育管理委员会项目(20165215),项目负责人:程祖珏
卫生部医药卫生科技发展研究中心项目(W2014ZT268),项目负责人:程祖珏~~
关键词
显微镜辅助
颈椎前路减压
颈椎病
传统直视
META分析
microscope-assisted
anterior approach
cervical spondylopathy
traditional direct view
meta-analysis
