中国组织工程研究

中国组织工程研究 ›› 2012, Vol. 16 ›› Issue (17): 3134-3138.doi: 10.3969/j.issn.1673-8225.2012.17.022

• 骨与关节循证医学 evidence-based medicine of the bone and joint • 上一篇    下一篇

颈前路2种减压并钢板植入内固定方式治疗相邻两节段脊髓型颈椎病的Meta分析★

张  威，廖文胜，王利民，鲍  恒   

  1. 郑州大学第一附属医院骨科，河南省郑州市  450052
  • 收稿日期:2011-12-26 修回日期:2012-02-06 出版日期:2012-04-22 发布日期:2012-04-22
  • 通讯作者: 廖文胜，副教授，硕士生导师，郑州大学第一附属医院骨科，河南省郑州市450052 hnzzlws@hotmail.com
  • 作者简介:张威★，男，1985年生，河南省尉氏县人，汉族，郑州大学第一附属医院在读硕士，主要从事脊柱外科的研究。 zwaf@163.com

Two anterior decompression and fusion treatments for two-level cervical spondylotic myelopathy: A Meta analysis 

Zhang Wei, Liao Wen-sheng, Wang Li-min, Bao Heng   

  1. Department of Orthopedics, First Affiliated Hospital of Zhengzhou University, Zhengzhou  450052, Henan Province, China
  • Received:2011-12-26 Revised:2012-02-06 Online:2012-04-22 Published:2012-04-22
  • Contact: Liao Wen-sheng, Associate professor, Master’s supervisor, Department of Orthopedics, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China hnzzlws@hotmail.com
  • About author:Zhang Wei★, Studying for master’s degree, Department of Orthopedics, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China zwaf@163.com

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摘要：

背景：相邻2个节段的脊髓型颈椎病主要有椎间盘切除植骨融合钢板内固定和椎体次全切除植骨融合钢板内固定两种方式，如何选择存在争议。
目的：比较椎间盘切除植骨融合内固定与椎体次全切除植骨融合内固定两种治疗方法对相邻2个节段脊髓型颈椎病治疗后生物力学特性的影响。
方法：计算机检索Cochrane Library(2011年第4期)、PubMed(1966/2011-11)、EMBASE(1974/2011-11)、CBM (1978/2011-11)、CNKI(1994/2011-11)、和万方数据库(1997/2011-11)，文献语种限为中文和英文。全面收集椎间盘切除植骨融合内固定与椎体次全切除植骨融合内固定2种方法治疗相邻2个节段的脊髓型颈椎病的对照研究，由2个研究者独立评价文献，使用 Cochrane 协作网提供的软件Revman 5.1进行Meta分析。
结果与结论：最终纳入分析的研究5个，共382例患者，其中椎间盘切除植骨融合内固定组201例，椎体次全切除植骨融合内固定组181例。Meta 分析的结果显示：在手术时间、出血量及术后颈椎曲度方面，椎间盘切除植骨融合内固定组与椎体次全切除植骨融合内固定组差异有显著性意义(P < 0.05)，而神经功能恢复情况、融合率及并发症方面，两组差异无显著性意义(P > 0.05)。对于相邻2个节段脊髓型颈椎病的手术治疗，椎间盘切除植骨融合内固定较椎体次全切除植骨融合内固定具有手术时间短，出血少，术后颈椎矫形较好的优点，而神经功能恢复情况、融合率及并发症与椎体次全切除植骨融合内固定接近。
关键词：颈前路钢板；融合；椎间盘切除植骨融合内固定；椎体次全切除植骨融合内固定；脊髓型颈椎病；Meta分析

关键词: 颈前路钢板, 融合, 椎间盘切除植骨融合内固定, 椎体次全切除植骨融合内固定, 脊髓型颈椎病, Meta分析

Abstract:

BACKGROUND: There are two main ways for cervical spondylotic myelopathy (CSM) in anterior approaches, one is anterior cervical discectomy with fusion (ACDF) and the other is anterior cervical corpectomy with fusion (ACCF). The optimal surgical strategy remains controversial for two-level CSM.
OBJECTIVE: To compare the clinical effects between ACDF and ACCF in treating two-level CSM.
METHODS: A computer-based online search of Cochrane Library (issue 4, 2011), PubMed database (1966/2011-11), EMBASE database (1974/2011-11), CBM database (1978/2011-11), CNKI database (1994/2011-11) and Wanfang database (1997/2010-11) was preformed for literatures in English and Chinese. All controlled studies of ACDF and ACCF for the treatment of two-level CSM were identified. Two reviewers assessed the trials and extracted data independently. Meta analysis was conducted with the Revman 5.1 software provided by Cochrane collaboration.
RESULTS AND CONCLUSION: A total of 382 cases in 5 controlled trials were included. Totally 201 patients were in the ACDF group and 181 patients were in the ACCF group. The results of Meta analysis showed that there were statistically significant differences in operation time, bleeding amount and cervical lordosis between ACDF group and ACCF group (P < 0.05), but there was no significant difference in the function recovery rate of spinal cord, fusion rate and complications between two groups (P > 0.05). Compared with ACCF, ACDF had the advantages of a shorter operation time, less bleeding and better cervical lordosis for two-level CSM. But there was no obvious difference in the function recovery rate of spinal cord, fusion rate and complications.
 

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