中国组织工程研究

中国组织工程研究 ›› 2026, Vol. 30 ›› Issue (15): 3983-3992.doi: 10.12307/2026.356

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

颈后路椎板成形后轴性症状的危险因素：系统评价与 Meta 分析

马  乐1，2，宋雨珂1，2，钟贤兴1，2，张文胜1，2   

  1. 1广州中医药大学第三附属医院骨科，广东省广州市   510378；2广东省中医骨伤研究院，广东省广州市   510378
  • 接受日期:2025-07-09 出版日期:2026-05-28 发布日期:2025-11-10
  • 通讯作者: 张文胜，硕士，主治医师，广州中医药大学第三附属医院骨科，广东省广州市 510378；广东省中医骨伤研究院，广东省广州市 510378
  • 作者简介:马乐，男，1995年生，广东省广州市人，汉族，硕士，主治医师，主要从事脊柱相关疾病防治的临床与基础研究。
  • 基金资助:
    广州中医药大学第三附属医院科研创新基金(Sy2023005)，项目负责人：马乐；广州中医药大学第三附属医院科研创新基金(Sy2023002)，项目负责人：张文胜；广东省中医药局科研项目(科研平台专项)(20254086)，项目负责人：张文胜

Risk factors for axial symptoms following posterior cervical laminoplasty: a systematic review and meta-analysis

Ma Le1, 2, Song Yuke1, 2, Zhong Xianxing1, 2, Zhang Wensheng1, 2   

  1. 1Department of Orthopedics, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510378, Guangdong Province, China; 2Guangdong Institute of Traditional Chinese Orthopedics and Traumatology, Guangzhou 510378, Guangdong Province, China
  • Accepted:2025-07-09 Online:2026-05-28 Published:2025-11-10
  • Contact: Zhang Wensheng, MS, Attending physician, Department of Orthopedics, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510378, Guangdong Province, China; Guangdong Institute of Traditional Chinese Orthopedics and Traumatology, Guangzhou 510378, Guangdong Province, China
  • About author:Ma Le, MS, Attending physician, Department of Orthopedics, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510378, Guangdong Province, China; Guangdong Institute of Traditional Chinese Orthopedics and Traumatology, Guangzhou 510378, Guangdong Province, China
  • Supported by:
    Scientific Research and Innovation Fund of the Third Affiliated Hospital of Guangzhou University of Chinese Medicine, No. Sy2023005 (to ML); Scientific Research and Innovation Fund of the Third Affiliated Hospital of Guangzhou University of Chinese Medicine, No. Sy2023002 (to ZWS); Scientific Research Project of Guangdong Provincial Administration of Traditional Chinese Medicine (Special Research Platform), No. 20254086 (to ZWS)

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摘要：

文题释义：

颈后路椎板成形：通过单开门或双开门的技术重建椎管形态，扩大椎管容积及椎管矢状径，从而直接解除了脊髓背侧的压迫。同时，依托颈椎生理性前凸的“弓弦”原理，间接缓解了脊髓受压，既实现了椎管减压又保留了颈椎的活动度。
轴性症状：是颈后路椎板成形术后最常见的并发症，临床表现为以颈肩背部疼痛为核心，伴有僵硬、酸胀、沉重感及肌肉痉挛等症状，常在术后早期出现，且持续时间通常较长，影响患者术后生活质量。

摘要
目的：轴性症状是颈后路椎板成形后最常见的并发症，严重影响患者的生活质量。目前尚无研究对轴性症状的危险因素进行系统分析，此次研究旨在通过Meta分析评估颈后路椎板成形术后轴性症状的发生率及危险因素，为临床诊疗提供循证医学证据。
方法：检索PubMed、Cochrane Library、Web of Science、Embase、中国知网、万方、维普及中国生物医学文献等数据库关于颈后路椎板成形术后轴性疼痛的病例-对照试验，检索时限为各数据库建库至2025年4月，根据不同数据库特征制定检索策略，提取纳入研究的基本特征、轴性症状发生率及相关危险因素，对纳入的文献进行偏倚风险评估和质量评价，采用R4.4.2进行Meta分析，评估轴性症状的发生率及危险因素。
结果：①共纳入17篇文献，总样本量2 156例，轴性症状发生率为34.88%(95%CI：0.301 6-0.399 0)，其中13篇文献为较高质量文献；②Meta分析结果显示，术前颈肩部疼痛(OR=2.35，95%CI：2.20-2.50)、颈椎曲度小于12°(OR=3.16，95%CI：1.91-5.24)、椎管占位率(OR=1.35，95%CI：1.02-1.79)、术中发生关节突关节损伤(OR=2.87，95%CI：1.96-4.19)、颈椎曲度变化(OR=1.10，95%CI：1.03-1.17)及颈椎活动度变化(OR=1.09，95%CI：1.04-1.14)为轴性症状的独立危险因素。
结论：术前颈肩部疼痛、颈椎曲度小于12°、术中发生关节突关节损伤以及术后颈椎曲度和活动度的变化被识别为颈后路椎板成形术后轴性症状的独立危险因素。对于具有以上高危因素的患者，需进行密切的随访及时干预，从而降低轴性症状的发生率，提高患者的生活质量。


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

关键词: 颈后路椎板成形, 轴性症状, 发生率, 危险因素, Meta分析, 颈椎曲度, 关节突关节损伤

Abstract: OBJECTIVE: Axial symptoms are among the most common complications following posterior cervical laminoplasty, significantly affecting patients' quality of life. Currently, there is no systematic analysis of the risk factors associated with axial symptoms. This study aims to evaluate the incidence and risk factors of axial symptoms through a meta-analysis, providing evidence-based guidance for clinical management.
METHODS: A systematic search was conducted in PubMed, Cochrane Library, Web of Science, Embase, CNKI, WanFang Data, VIP, and Chinese Biomedical Literature Database for case-control studies on axial symptoms following cervical open-door laminoplasty. The search period extended from the inception of each database to April 2025. Search strategies were tailored to the characteristics of each database. Basic characteristics, incidence rates, and risk factors for axial symptoms were extracted from the included studies. Risk of bias and quality of the included studies were assessed. Meta-analysis was performed using R software (version 4.4.2) to evaluate the incidence and risk factors of axial symptoms.
RESULTS: (1) A total of 17 studies involving 2 156 patients were included in the analysis. The overall incidence of axial symptoms was 34.88% (95%CI: 0.301 6-0.399 0). Of them, 13 articles were of high quality. (2) Meta-analysis identified the following as independent risk factors for axial symptoms: preoperative neck and shoulder pain (OR=2.35, 95%CI: 2.20-2.50), cervical curvature < 12° (OR=3.16, 95%CI: 1.91-5.24), canal occupancy rate (OR=1.35, 95%CI: 1.02-1.79), facet joint violation (OR=2.87, 95%CI: 1.96-4.19), changes in cervical curvature (OR=1.10, 95%CI: 1.03-1.17), and changes in cervical range of motion (OR=1.09, 95%CI: 1.04-1.14).
CONCLUSION: Preoperative neck and shoulder pain, cervical curvature < 12°, intraoperative facet joint violation, and postoperative changes in cervical curvature and range of motion were identified as independent risk factors for axial symptoms. Patients with these high-risk factors should be closely monitored and provided with timely interventions to reduce the incidence of axial symptoms and improve their quality of life.

Key words: posterior cervical laminoplasty, axial symptom, incidence, risk factor, meta-analysis, cervical curvature, facet joint violation

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