颈前路应用Zero-P椎间融合系统与钛板联合cage融合系统治疗颈椎病的Meta分析

Cervical anterior Zero-P fusion system versus cage fusion system combined with titanium plate for the treatment of cervical spondylosis: a Meta-analysis

中文关键词:  颈椎病  颈前路椎间盘切除融合术  Zero-P椎间融合系统  Meta分析

英文关键词:Cervical spondylosis  Anterior cervical discectomy and fusion  Zero-profile device  Meta-analysis

中文摘要:

  【摘要】 目的：比较颈前路应用Zero-P椎间融合系统与钛板联合cage椎间融合系统治疗颈椎病的疗效与安全性。方法：通过计算机检索PubMed、Embase、Cochrane Library、中国知网数据库2008年1月~2018年6月对比Zero-P椎间融合系统与传统钛板联合cage椎间融合系统治疗颈椎病的临床研究文献，按照纳入与排除标准选择文献，以纽卡斯尔渥太华评分（Newcastle Ottawa scale，NOS）对纳入文献进行质量评价，提取数据包括手术时间、术中出血量、术后吞咽困难发生情况、手术前后日本骨科协会（Japanese Orthopaedic Association，JOA）评分、颈椎功能障碍指数（neck disability index，NDI）、上肢痛视觉模拟评分（visual analogue score，VAS）、C3~C7 Cobb角、融合率、邻近节段退变。使用Revman 5.3软件进行Meta分析，用固定效应模型或随机效应模型进行数据合并，计算比值比（odds ratio，OR）/标准化均数差（standardized mean difference，SMD）/危险度差值（risk difference，RD）和95％可信区间（confidence interval，CI）。以漏斗图判定发表偏倚。结果：共有14篇文献总计1159例患者（Zero-P组546例患者，钛板组613例患者）纳入研究。文献质量评价6篇为9分，4篇为8分，4篇为7分。Meta分析结果显示，应用Zero-P椎间融合系统患者的手术时间[SMD=-0.60，95%CI（-0.73，0.46），P＜0.01]、术中出血量[SMD=-0.50，95%CI（-0.64，-0.37），P＜0.01]、术后吞咽困难发生率[RD=-0.09，95%CI（-0.14，-0.04），P＜0.01]及慢性吞咽困难发生率[RD=0.14，95%CI（0.06，0.31），P＜0.01]显著低于应用钛板联合cage椎间融合系统的患者。两组手术前后JOA评分、NDI、VAS评分、Cobb角、融合率及邻近节段退变无显著性差异（P>0.05）。漏斗图显示无明显发表偏倚。结论：与应用钛板联合cage椎间融合系统相比，应用Zero-P椎间融合系统治疗颈椎病亦具有满意的疗效，且能显著减少手术时间、术中出血量，并减少术后吞咽困难发生情况，具有较高的安全性。

英文摘要:

  【Abstract】 Objectives: To compare the efficacy and safety of two different intervertebral fusion in the surgical treatment of cervical spondylosis. Methods: Literatures for the surgical treatment of cervical spondylosis by using the Zero-P intervertebral fusion system and cage intervertebral fusion system combined with titanium plate between January 2008 and June 2018 were collected from the databases(PubMed, Embase, Cochrane Library, CNKI). Literatures were selected according to inclusion and exclusion criteria and evaluated by Newcastle Ottawa scale (NOS). The extracted data included operation time, intraoperative blood loss, postoperative dysphagia, cervical Japanese Orthopaedic Association(JOA) score, neck disability index(NDI) score, visual analogue score(VAS), Cobb angle, fusion rate and incidence of adjacent segment degeneration after surgery. Meta analysis was performed by using the software Revman 5.3, and data were pooled by using a fixed effect model or a random effect model to calculate the odds ratio(OR)/standardized mean difference(SMD)/risk difference(RD) and 95% confidence interval(CI). Publication bias was determined by the funnel plot. Results: A total of 1159 patients (Zero-P 546 patients, cage fusion 613 patients) from 14 literatures was included in the study. Six literatures scored 9 points, four scored 8 points and four scored 7 points in the literatures quality evaluation. Meta-analysis showed that operation time, intraoperative blood loss, incidence of postoperative dysphagia and chronic dysphagia of the intervertebral fusion system with Zero-P were significantly lower than those of cage intervertebral fusion system combined with titanium plate. There was no significant difference in cervical JOA score, DNI, VAS score, Cobb angle, fusion rate or incidence of adjacent segment degeneration after surgery between two devices. Funnel plot showed no obvious publication bias. Conclusions： Compared with intervertebral fusion system combined with titanium plate, cervical anterior Zero-P fusion shows a more satisfactory effect in the treatment of cervical spondylosis. Cervical anterior Zero-P fusion is also safer for its reduction of operation time, intraoperative blood loss and postoperative dysphagia.