中国组织工程研究

中国组织工程研究 ›› 2019, Vol. 23 ›› Issue (8): 1299-1306.doi: 10.3969/j.issn.2095-4344.1056

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

颈椎后路单开门与双开门椎管成形治疗脊髓型颈椎病的Meta分析

梁 龙1，2，魏 戌1，2，朱立国1，2，银 河1，2，于 杰1，2，冯敏山1，2，陈 琳1，2   

  1. 1中国中医科学院望京医院，北京市 100102；2中医正骨技术北京市重点实验室，北京市 100102
  • 出版日期:2019-03-18 发布日期:2019-03-18
  • 通讯作者: 朱立国，博士，主任医师，中国中医科学院望京医院脊柱二科，北京市 100102 银河，在读博士，主治医师，中国中医科学院望京医院脊柱二科，北京市 100102
  • 作者简介:梁龙，男，1990年生，安徽省滁州市人，汉族，中国中医科学院在读博士，医师，主要从事脊柱及相关疾病研究。
  • 基金资助:

    中医药行业科研专项(201407001-11)，项目负责人：朱立国

Cervical posterior single-door laminoplasty versus double-door laminoplasty for cervical spondylotic myelopathy: a meta-analysis

Liang Long1, 2, Wei Xu1, 2, Zhu Liguo1, 2, Yin He1, 2, Yu Jie1, 2, Feng Minshan1, 2, Chen Lin1, 2   

  1. 1Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing 100102, China; 2Beijing Key Laboratory of Orthopedics of Traditional Chinese Medicine, Beijing 100102, China
  • Online:2019-03-18 Published:2019-03-18
  • Contact: Zhu Liguo, MD, Chief physician, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing 100102, China; Beijing Key Laboratory of Orthopedics of Traditional Chinese Medicine, Beijing 100102, China Yin He, Doctoral candidate, Attending physician, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing 100102, China; Beijing Key Laboratory of Orthopedics of Traditional Chinese Medicine, Beijing 100102, China
  • About author:Liang Long, Doctoral candidate, Physician, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing 100102, China; Beijing Key Laboratory of Orthopedics of Traditional Chinese Medicine, Beijing 100102, China
  • Supported by:

    the Research Project of Traditional Chinese Medicine, No. 201407001-11 (to ZLG)

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摘要：

文章快速阅读：

 
 
文题释义：
颈椎后路单开门椎管成形：是以一侧椎弓根与椎板连接处为轴，将对侧椎板切断，向后外侧移开椎板，从而扩大椎管的矢状径，解除脊髓受压情况，并且还可以最大限度的保留颈椎的活动度和稳定性。但也需要控制开门角度及椎管矢状径扩大程度，过小则解压不充分，过大则造成脊髓过多后移，容易引起C5神经根麻痹等并发症。
颈椎后路双开门椎管成形：是在颈椎椎板与双侧椎弓根之间制造门轴，这样可以维持持续开门状态。颈椎双开门可以有效避免单开门术后再关门现象，并且能够较好的保留颈椎后部结构，可保持颈椎术后的稳定性，一定程度上避免硬膜粘连的发生，但手术步骤复杂，容易造成脊髓的损伤及硬脊膜的撕裂。
 
摘要
背景：对于颈椎单开门及双开门椎管成形治疗脊髓型颈椎病的临床效果是否存在差异，一些研究得出相互矛盾的结论，即便关于这2种术式的Meta分析也得出了不同的结果。
目的：系统评价颈椎后路单开门与双开门椎管成形治疗脊髓型颈椎病的有效性及安全性。
方法：计算机检索所有关于颈椎后路单开门椎管成形与双开门椎管成形治疗脊髓型颈椎病的国内外临床试验。由2 名研究人员独立进行文献筛选、数据提取和纳入文献评价，用Cochrane协作网提供的偏倚风险评估工具对纳入随机对照试验进行质量评价，以NOS量表进行回顾性研究的质量评价，使用RevMan 5.3软件进行Meta分析。

结果与结论：①共纳入14篇文献，共893例患者；②Meta分析结果显示：2种术式在改善脊髓型颈椎病患者目测类比评分[SMD=0.24，95%CI(-0.64，1.11)，P=0.60]、日本骨科协会评分[SMD=0.15，95%CI(-0.23，0.52)，P=0.44]、日本骨科协会评分恢复率[MD=0.02，95%CI(-0.02，0.06)，P=0.33]、Nurick分级[SMD=-0.34，95%CI(-0.73，0.05)，P=0.09]、手术时间[SMD=-0.21，95%CI(-0.43，0.02)，P=0.07]、出血量[SMD=0.28，95%CI(-0.20，0.77)，P=0.25]、颈椎曲度[MD=0，95%CI(-0.49，0.77)，P=1.00]、活动度[SMD=0.41，95%CI(-0.48，1.31)，P=0.37]等方面差异均无显著性意义；③在椎管容积增加率方面[MD=0.18，95%CI(0.06，0.30)，P=0.003]，颈椎单开门椎管成形术优于双开门手术；单颈椎双开门手术的术后并发症明显低于单开门手术[RR=1.5，95%CI(1.04，2.15)，P=0.03]，尤其体现在术后疼痛症状方面[RR=6.35，95%CI (1.93，20.92)，P=0.002]；④结果表明，与颈椎后路单开门椎管成形相比，双开门椎管成形可以更显著的减少并发症发生率，其他临床疗效二者相似；但单开门椎管成形在提高椎管容积增加率方面更具优势，因此仍需大量高质量的研究提供更充足的证据。

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程
ORCID: 0000-0001-7193-8547(梁龙)

关键词: 脊髓型颈椎病, 颈椎单开门椎管成形术, 颈椎双开门椎管成形术, 颈椎后路单开门, 椎管容积, 椎管成形

Abstract:

BACKGROUND: Whether treatment outcomes of single-door laminoplasty are different from double-door laminoplasty for cervical spondylotic myelopathy remains controversial. Even relevant meta-analysis obtains different conclusions.

OBJECTIVE: To systematically evaluate the efficacy and safety of cervical posterior single-door laminoplasty versus double-door laminoplasty in the treatment of cervical spondylotic myelopathy.
METHODS: Clinical trials of single-door laminoplasty versus double-door laminoplasty for cervical spondylotic myelopathy were retrieved. Literature screening, data extraction and literature evaluation were conducted by two researchers independently. The quality of the included randomized controlled trials was assessed with the bias risk assessment tool provided by Cochrane Collaborative Network. The quality of the retrospective studies was assessed with the Newcastle-Ottawa Scale score and meta-analysis was performed on RevMan 5.3 software.
RESULTS AND CONCLUSION: (1) A total of 14 articles were included, involving 893 patients. (2) The meta-analysis results showed that there were no significant differences in the Visual Analogue Scale scores [SMD=0.24, 95%CI (-0.64, 1.11), P=0.60], Japan Orthopaedic Association scores [SMD=0.15, 95%CI (-0.23, 0.52), P=0.44], Japan Orthopaedic Association recovery rate [MD=0.02, 95%CI (-0.02, 0.06), P=0.33], Nurick grade [SMD=-0.34, 95%CI (-0.73, 0.05), P=0.09], operation time [SMD=-0.21, 95%CI (-0.43, 0.02), P=0.07], blood loss [SMD=0.28, 95%CI (-0.20, 0.77), P=0.25], cervical lordosis [MD=0, 95%CI (-0.49, 0.77), P=1.00], range of motion [SMD=0.41, 95%CI (-0.48, 1.31), P=0.37] between two methods. (3) In terms of cervical canal enlargement rate, single-door laminoplasty was superior to double-door laminoplasty [MD=0.18, 95%CI (0.06, 0.30), P=0.003]. The postoperative complications of double-door laminoplasty were significantly lower than those of single-door laminoplasty [RR=1.5, 95%CI (1.04, 2.15), P=0.03], especially in postoperative pain symptoms [RR=6.35, 95%CI (1.93, 20.92), P=0.002]. (4) In summary, all clinical effects of cervical posterior double-door laminoplasty are similar to single-door laminoplasty, except for the few complications. But single-door laminoplasty can increase the spinal canal volume enlargement rate, so a large number of high-quality studies are needed to provide sufficient evidence.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Cervical Vertebrae, Vertebroplasty, Blood Loss, Surgical, Meta-Analysis, Tissue Engineering

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