颈椎间盘置换与颈前路减压植骨融合治疗单节段颈椎病中期疗效的Meta分析

Meta-analysis on the mid-term effects of cervical disc arthroplasty versus anterior cervical discectomy and fusion for single-level cervical spondylosis

中文关键词:  颈椎间盘置换术  颈前路减压植骨融合术  中期疗效  Meta分析  系统评价  随机对照试验

英文关键词:Cervical disc arthroplasty  Anterior cervical discectomy and fusion  Mid-term effects  Meta-analysis  Systematic review  Randomized controlled trial

中文摘要:

  【摘要】 目的：通过和颈前路减压植骨融合（ACDF）术对比，评价颈椎间盘置换（cervical disc arthroplasty，CDA）治疗单节段颈椎病的中期疗效。方法：计算机检索2013年10月1日以前PubMed、Medline、Embase、Cochrane图书馆、中国生物医学文献数据库（CBM）、中国期刊全文数据库（CNKI）、维普中文科技期刊数据库（VIP）和万方数据库中关于CDA与ACDF比较治疗单节段颈椎病的随机对照试验（randomized controlled trials，RCT）且随访时间≥4年的文献，纳入文献的方法学质量采用改良Jadad量表评价，提取各研究中的术后末次随访时颈部功能障碍指数（neck disability index，NDI）、SF-36评分、颈痛和上肢痛VAS评分、神经功能改善率、手术节段活动度、手术节段和邻近节段再手术率、术后总并发症发生率等指标，并将这些研究的数据通过Review Manager 5.2软件进行Meta分析与综合。结果：共纳入7篇文献、1622例患者，随访时间4~5年，CDA组826例，ACDF组796例。7篇纳入文献的方法学质量评分为4~6分，其中4分2篇，5分3篇，6分2篇。Meta分析结果显示：CDA与ACDF比较，术后中期（术后4~5年）的神经功能改善率[相对危险度（RR）=1.04，95%CI（1.00，1.09），P=0.07]、颈痛VAS评分[标准化均数差（SMD）=-0.12，95%CI（-0.27，0.04），P=0.13] 和总并发症发生率[RR=1.06，95%CI（0.57，1.96），P=0.86]差异无统计学意义。与ACDF比较，CDA术后中期SF-36评分较优[SMD=0.24，95%CI（0.08，0.39），P=0.003]、手术节段活动度较大[SMD=7.38，95%CI（5.87，8.89），P<0.00001]、NDI较低[SMD=-0.26，95%CI（-0.40，-0.13），P=0.0002]、上肢痛VAS评分较低[SMD=-0.17，95%CI（-0.33，0.02），P=0.03]、手术节段再手术率较低[（RR=0.48，95%CI（0.31，0.75），P=0.001]、邻近节段再手术率较低[RR=0.60，95%CI（0.37，0.98），P=0.04]。结论：CDA治疗单节段颈椎病的中期疗效优于ACDF。

英文摘要:

  【Abstract】 Objectives: To assess the mid-term effects of cervical disc arthroplasty(CDA) versus anterior cervical discectomy and fusion(ACDF) for single-level cervical spondylosis． Methods: According to the method of systematic review of Cochrane, PubMed, Medline, EMBASE, Cochrane Library, CBM, CNKI, VIP database, Wanfang database before October 1st, 2013 were searched for articles comparing CDA and ACDF for single-level cervical spondylosis． All randomized controlled trials(RCTs) were included for the present study. Two authors independently assessed trial quality and extracted data． Data of NDI score, SF-36 score, rate of neurologic success, VAS score of neck pain, VAS score of arm pain, range of motion in operation level, reoperation rate at operation level, reoperation rate at adjacent level, total complication rate at last follow-up after operation from these studies were abstracted and synthesized by Review Manager 5.2 for Meta-analysis． Results: Seven studies with a total of 1622 patients were included(826 in the CDA group and 796 in the ACDF group, with 4-5 year follow-up)． The methodological quality score of studies included in the Meta-analysis was from 4 to 6． Of them, two studies were score 4, three studies is score 5 and the other two studies is score 6． Meta-analysis indicated that no differences were found in the rate of neurologic success[(RR= 1.04, 95%CI(1.00, 1.09), P=0.07], VAS score of neck pain[SMD=-0.12, 95%CI(-0.27, 0.04), P=0.13] and the total complication rate[RR=1.06, 95%CI(0.57, 1.96), P=0.86] between two groups. Compared with ACDF, CDA had better SF-36 score[SMD=0.24, 95%CI(0.08, 0.39), P=0.003], larger range of motion in operation level[SMD=7.38, 95%CI(5.87, 8.89), P<0.00001], lower NDI score[SMD=-0.26, 95%CI(-0.40, -0.13), P=0.0002), lower VAS score of arm pain[SMD=-0.17, 95%CI(-0.33, 0.02), P=0.03), lower reoperation rate at operation level[RR=0.48, 95%CI(0.31, 0.75), P=0.001] and lower reoperation rate at adjacent levels[RR=0.60,95%CI(0.37, 0.98), P=0.04] at mid-term follow-up. Conclusions: For single-level cervical spondylosis, CDA appears to provide better clinical effects than ACDF at mid-term follow-up.