摘要
背景:大量研究已证实前路手术和后路手术治疗多节段脊髓型颈椎病均有较好疗效,但两种治疗方法孰优孰劣,目前尚无定论。目的:系统评价前路与后路手术治疗多节段脊髓型颈椎病的疗效及安全性。方法:计算机检索Cochrane图书馆(2013年第3期)、PubMed(1966年至2013年3月)、OVID(1950年至2013年3月)、EMbase(1966年至2013年3月)、中国生物医学文献数据库(1978年至2013年3月)、万方数据库(1998年至2013年3月)、中国期刊全文数据库(1999年至2013年3月),手工检索《中华外科杂志》等5种相关杂志,收集前路与后路手术比较治疗多节段脊髓型颈椎病的随机或非随机对照实验,由两名评价者按纳入与排除标准选择文献、提取资料和质量评价后,采用RevMan5.2软件进行Meta分析。结果与结论:最终纳入11个对照实验,共814例患者。Meta分析结果显示:与后路手术相比,前路手术治疗后JOA评分高(P<0.000 01),神经功能改善率高(P=0.000 3),C5神经根麻痹发生率低(P=0.007),但手术操作时间长(P<0.000 01),出血量大(P=0.000 7),临近节段退变发生率高(P=0.01),术后并发症发生率高(P<0.000 01),再手术率较高(P=0.003)。两组颈椎活动度比较差异无显著性意义(P=0.56)。由于纳入研究数量有限且方法学质量不高,研究结果尚需更多高质量的随机对照实验进一步证实。
BACKGROUND： A large number of studies have confirmed that anterior approach and posterior approach for multilevel cervical spondylotic myelopathy were effective, but there is still no conclusion in which one is better.
OBJECTIVE： To systematically assess the clinical effectiveness and safety of anterior approach versus posterior approach for multilevel cervical spondylotic myelopathy.
METHODS： The databases such as The Cochrane Library （Issue 3, 2013）, PubMed （from 1966 to March 2013）, OVID （from 1950 to March 2013）, EMbase （from 1966 to March 2013）, Chinese Biomedical Literature Database （from 1978 to March 2013）, WanFang Database （from 1998 to March 2013）, China National Knowledge Infrastructure （from 1999 to March 2013） were electronically searched and five relevant journals were searched by hand to collect the randomized controlled trials or non-randomized controlled trials about the clinical effectiveness and safety of anterior approach versus posterior approach for multilevel cervical spondylotic myelopathy. Two reviewers independently screened the literature according to the inclusive and exclusive criteria, extracted the data, and assessed the methodological quality of included studies. Then the meta-analysis was performed by using RevMan5.2 software.
RESULTS AND CONCLUSION： A total of 11 controlled trials involving 814 patients were included. Meta-analysis results showed that, compared with posterior approach, postoperative Japanese Orthopaedic Association scores were better （P 〈 0.000 01）, improvement rate of neurological function was higher （P=0.000 3）, the incidence of C5 root palsy was lower （P=0.007）, but operation time was longer （P 〈 0.000 01）, amount of intraoperative bleeding was larger （P=0.000 7）, incidence of adjacent segments degeneration was higher （P=0.01）, incidence of postoperative complications was higher （P 〈 0.000 01） and the rate of secondary surgical procedures was higher （P=0.003） after anterior approach. Additionally, there were no differences between the two groups in the cervical range of motion （P=0.56）. For quantity limitation and low methodological quality of included studies, this conclusion still needs to be further proved by performing more high-quality and large-scale randomized controlled trials.
出处
《中国组织工程研究》
CAS
CSCD
2014年第4期637-644,共8页
Chinese Journal of Tissue Engineering Research
