颈椎间盘置换术与颈前路椎间融合术治疗双节段颈椎间盘退变性疾病疗效的Meta分析

Meta-analysis of artificial disc replacement versus anterior cervical discectomy and fusion in double-segment cervical disc disease

中文关键词:  颈椎间盘置换术  颈前路椎间盘切除椎间植骨融合术  双节段  Meta分析

英文关键词:Total cervical disc replacement  Anterior cervical discectomy fusion  Two-level  Meta-analysis

中文摘要:

  【摘要】 目的：系统评价颈椎间盘置换术（TDR）与颈前路椎间盘切除椎间植骨融合术（ACDF）治疗相邻两个节段颈椎间盘退变性疾病的疗效。方法：检索Pubmed、Medline、Embase等数据库，筛选应用两种手术方式治疗相邻两个节段颈椎间盘退变性疾病的前瞻性临床对照研究；各研究中观察组术式为TDR（TDR组），对照组术式为ACDF（ACDF组）；两组病例数均不少于10例；随访时间均不少于2年；术后疗效评价指标至少包括以下指标中的一项：颈痛及上肢痛VAS评分（VAS），颈部功能障碍指数（NDI），健康调查简表SF-36评分（SF-36），术后不良事件（AE）等指标。采用Doowns-Black评分及NOS评分评价纳入研究的质量。结果：共纳入5篇英文文献，2篇为随机对照研究（RCT），3篇为前瞻性队列研究，研究质量Doowns-Black评分均在18分及以上，NOS评价前瞻性队列研究质量均为6星。共纳入593例患者，其中TDR组314例，ACDF组279例。经Meta分析合并效应指标，末次随访时颈痛VAS评分标准化均数差（SMD）及不良事件发生相对危险度（RR）两组比较无显著性差异（P＞0.05）；TDR组上肢痛VAS评分、NDI评分、邻近上节段和下节段屈伸ROM、邻近节段退变低于ACDF组（P＜0.05），SF36-PCS躯体健康评分及手术节段屈伸ROM SMD高于ACDF组（P＜0.05）。结论：相邻两个节段颈椎间盘退变性疾病行TDR的疗效较ACDF具有优势，安全性较高，但需要更多大样本随机对照研究以及更长时间的随访结果来验证。

英文摘要:

  【Abstract】 Objectives: To assess and compare the effectiveness and safety of total cervical disc replacement(TDR) and anterior cervical discectomy and fusion(ACDF) for double-segment cervical disc disease. Methods: The search was made in PubMed, Medline, Embase. The criterion of articles needed for system assessment should have included: (1)clinical control trails with application of two kinds of surgical treatment with double- segmental cervical spondylosis; (2)the treatment group received cervical disc replacement, while the control group received ACDF; (3)the number of patients must be more than 10 both in treatment group and control group; (4)the evaluation of postoperative effects must include visual analog scale(VAS) neck disability index(NDI) and the range of motion(ROM) of targeted levels etc. Doowns-Black score grade and NOS were applied to evaluate the quality of included studies. Results: There were 5 studies which included 593 patients(314 patients for Bryan cervical disc replacement, 279 patients for ACDF) in our system assessment. All articles were from English literature, among them 2 were random controlled trails while the rest were prospective cohort studies. The scores of Doowns-Black score system were 18 and above, the scores of NOS system were 6 stars and above. The meta-analysis showed that the standardized mean differences(SMD) of neck pain VAS score and relative risk(RR) of adverse events in the two groups were not significantly different(P>0.05); For the standardized mean differences(SMD) of upper limb pain VAS score, NDI score, ROM of flexion and extension of adjacent segment and relative risk(RR) of adjacent segment degeneration, those in TDR group were lower than those in ACDF group(P<0.05). SF36 PCS body health score and ROM of flexion and extension of operated segment in TDR group were higher than those in ACDF group(P<0.05). Conclusions: Our results indicate that total cervical disc replacement for double-segment cervical disc disease is safe and superior than ACDF in therapeutic effectiveness. But this needs more large sample randomized controlled trials and longer follow-up study.