摘要
目的系统评价后路经皮内镜下颈椎间盘切除术(posterior percutaneous endoscopic cervical discectomy,PPECD)与前路颈椎间盘切除融合术(anterior cervical discectomy and fusion,ACDF)治疗神经根型颈椎病(cervical spondylotic radiculopathy,CSR)的有效性和安全性。方法在PubMed、Embase、Web of Science、Cochrane library、中国期刊全文数据库(CNKI)和万方数据库中检索2020年10月前公开发表的关于PPECD和ACDF治疗单节段CSR的对照研究。评价指标包括手术前后的颈部疼痛视觉模拟评分(visual analog score neck,VASN)、上肢疼痛视觉模拟评分(visual analog score arm,VASA)、颈部功能障碍指数(neck disability index,NDI)、并发症发生率、手术时间及住院时间。采用RevMan 5.3软件进行Meta分析。结果共纳入5篇非随机对照研究,共计297例。Meta分析结果表明,两组患者的年龄、性别、术前疼痛程度及颈椎功能状态差异均无统计学意义。PPECD组术后VASA评分略优于ACDF组(WMD=-0.04;95%CI:-0.08~-0.01;P=0.02),而VASN评分(WMD=-0.21;95%CI:-0.50~0.08;P=0.16)、NDI(WMD=0.27;95%CI:-0.05~0.59;P=0.10)、并发症发生率(OR=0.96;95%CI:0.37~2.45;P=0.92)及手术时间(WMD=7.86;95%CI:-37.32~53.03;P=0.73)等指标与ACDF组差异均无统计学意义。PPECD组住院时间显著短于ACDF组,差异有统计学意义(WMD=-2.80;95%CI:-3.76~-1.84;P<0.0001)。结论PPECD和ACDF均能显著改善CSR患者的临床症状,在功能预后、手术时间及并发症发生率等方面两者疗效相当,但前者手术创伤小,花费少,住院时间较短,术后康复更快。
Objective A systematic review of the effectiveness and safety of posterior percutaneous cervical discectomy(PPECD)and anterior cervical discectomy and fusion(ACDF)in the treatment of cervical spondylotic radiculopathy(CSR).Methods Comparative studies on single-segment CSR by PPECD and ACDF treatment published before October 2020 were retrieved in PubMed,Embase,Web of Science,Cochrane Library,CNKI and Wanfang database.Evaluation indexes:Preoperative visual analogue scale neck(VASN);preoperative visual analogue scale arm(VASA);postoperative VASN;postoperative VASA;preoperative neck disability index(NDI);postoperative NDI;complication rate;operation time;hospital stay.The meta-analysis was carried out by RevMan 5.3software.Results A total of 5 non-randomized controlled studies were included,with a total of 297 patients.The results of meta-analysis showed that there were no statistically significant differences in age,gender,preoperative pain and cervical spine functional status between the two groups.The PPECD group had a slightly better postoperative VASA score than the ACDF group(WMD=-0.04;95%CI:-0.08--0.01;P=0.02),while the VASN score(WMD=-0.21;95%CI:-0.50-0.08;P=0.16),NDI(WMD=0.27;95%CI:-0.05-0.59;P=0.10),complication rate(OR=0.96;95%CI:0.37-2.45;P=0.92)and operative time(WMD=7.86;95%CI:-37.32-53.03;P=0.73)were not statistically significant from the ACDF group.The hospital stay of PPECD group was significantly shorter than that of ACDF group(WMD=-2.80,95%CI:-3.76--1.84,P<0.0001).Conclusions Both PPECD and ACDF can significantly improve the clinical symptoms of patients with single-segment CSR.Both methods achieve similar effect in terms of functional prognosis,operation time and complication rate.However,the average hospital stay of the former is shorter,and the postoperative recovery is faster.
作者
郝尹泽
刘松旗
李庆达
HAO Yin-ze;LIU Song-qi;LI Qing-da(Xi’an Medical College,Xi’an,Shaanxi,710021,China)
出处
《中国骨与关节杂志》
CAS
2022年第9期668-675,共8页
Chinese Journal of Bone and Joint
