摘要
背景:目前治疗多节段脊髓压迫性脊髓病的主要术式为颈后路单开门微型钛板内固定椎管扩大成形及颈后路全椎板减压侧块螺钉内固定,然而,这2种术式在临床中的优越性仍有很大争议,关于两者比较的相关文献较多,但大多因为样本量的局限未予以客观的评价。目的:通过Meta分析来比较接受以上2种颈后路术式治疗多节段脊髓压迫性脊髓病的临床结果、安全性及术后并发症情况,进一步评价2种术式的优缺点。方法:在CNKI、WANGFANG、VIP、PubMed、Embase、Cochrane图书馆和Science Direct数据库中检索关于颈后路单开门微型钛板内固定椎管扩大成形和颈后路全椎板减压侧块螺钉内固定比较的随机或非随机对照试验文献,同时手动检索纳入文献的参考文献。从纳入文献中提取以下结果指标:手术时间,术中出血量、日本骨科协会评分、目测类比评分、颈椎曲度指数、颈椎功能障碍指数、C5神经根麻痹、轴性症状、后凸畸形及其他并发症数据。使用STATA 15.1进行数据分析。结果与结论:①共纳入16项回顾性队列研究,共1 666例患者;②Meta分析结果显示,微型钛板组在手术时间[WMD=-20.090, 95%CI(-27.759,-12.421), P<0.00001]及术中出血量[WMD=-42.519,95%CI(-66.368,-18.670),P<0.00001]上均优于侧块螺钉组;③2组术式在术后日本骨科协会评分[WMD=0.092,95%CI(-0.177,0.361),P=0.502> 0.05]、术后目测类比评分[WMD=-0.247,95%CI(-0.667,0.172),P=0.248> 0.05]、术后颈椎曲度指数[WMD=-0.314,95%CI(-1.070,0.441),P=0.415> 0.05]、术后Cobb角[WMD=0.193,95%CI(-0.116,0.502),P=0.220> 0.05]上差异无显著性意义;④微型钛板组术后颈椎功能障碍指数[WMD=-1.361,95%CI(-2.219,-0.503),P=0.002 <0.05]及轴性症状[RR=0.572,95%CI(0.43,0.759),P <0.000 01]、C5神经根麻痹[RR=0.313,95%CI(0.211,0.465),P <0.000 01]、总并发症发生率[RR=0.521,95%CI(0.426,0.637),P <0.000 01]均低于侧块螺钉组;⑤提示临床上治疗多�
BACKGROUND: The main surgical procedures for treating multilevel cervical compressive myelopathy are posterior expansive unilateral open-door laminoplasty with titanium mini-plate and posterior cervical laminectomy with lateral mass screw fixation. However, the superiority of these two methods in clinical practice is still controversial. Relative comparative studies are various, but there is a lack of objective evaluation due to sample size.OBJECTIVE: To compare the efficacy, safety and postoperative complications of patients with multilevel cervical compressive myelopathy treated by these two procedures, and to further analyze their advantages and disadvantages.METHODS: CNKI, WanFang, VIP, PubMed, Embase, Cochrane Library and Science Direct databases were searched for the randomized controlled trials or nonrandomized controlled trials concerning posterior expansive unilateral open-door laminoplasty with titanium mini-plate versus posterior cervical laminectomy with lateral mass screw fixation. The following outcome measures were extracted: operation time,intraoperative blood loss, Japanese Orthopaedic Association scores, Visual Analog Scale, cervical curvature index, cervical dysfunction index,C5 nerve root paralysis, axial symptoms and other complications. Data analysis was conducted on STATA 15.1 software.RESULTS AND CONCLUSION:(1) A total of 16 studies, involving 1 666 patients.(2) Meta-analysis results showed that in the titanium mini-plate group, the operation time [WMD=-20.090, 95%CI(-27.759,-12.421), P < 0.000 01] and intraoperative blood loss [WMD=-42.519, 95%CI(-66.368,-18.670), P < 0.000 01] were superior to the lateral mass screw group.(3) There were no significant differences in the postoperative Japanese Orthopaedic Association score [WMD=-0.092, 95%CI(-0.177,-0.361), P=0.502 > 0.05], postoperative Visual Analog Scale score[WMD=-0.247, 95%CI(-0.667, 0.172), P=0.248 > 0.05], postoperative cervical curvature index [WMD=-0.314, 95%CI(-1.070, 0.441), P=0.415 >0.05], and postoperative Cobb angle [WMD=0.1
作者
汪伟
马均峰
崔子健
张黎龙
江泽华
陆芸
Wang Wei;Ma Junfeng;Cui Zijian;Zhang Lilong;Jiang Zehua;Lu Yun(Tianjin Medical University,Tianjin 300070,China;Tianjin People’s Hospital,Tianjin 300121,China;Tianjin Hospital,Tianjin 300210,China)
出处
《中国组织工程研究》
CAS
北大核心
2019年第16期2614-2624,共11页
Chinese Journal of Tissue Engineering Research
关键词
单开门椎管成形
侧块螺钉
椎板切除术
微型钛板
钛板内固定
椎管扩大成形
椎板矢状径
META分析
unilateral open-door laminoplasty
lateral mass screw
laminectomy
titanium mini-plate
internal fixation with titanium plate
expansive laminectomy
vertebral plate sagittal diameter
meta-analysis
