颈椎人工椎间盘置换术与颈椎前路减压融合术治疗双节段颈椎病的Meta分析

Meta-analysis on anterior cervical artificial disc replacement versus anterior cervical decompression and fusion for bi-level cervical spondylosis

中文关键词:  前路颈椎人工间盘置换术  前路颈椎减压融合术  颈椎病  双节段  随访  Meta分析

英文关键词:Anterior cervical artificial disc replacement  Anterior cervical decompression and fusion  Bi-level cervical spondylosis  Follow-up  Meta-analysis

中文摘要:

  【摘要】 目的：系统评价前路颈椎人工椎间盘置换术（anterior cervical artificial disc replacement，ACDR）与前路颈椎减压融合术（anterior cervical decompression and fusion，ACDF）治疗双节段颈椎病的有效性与安全性。方法：计算机检索2016年5月1日以前PubMed、Embase、Medline、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）、万方数据库（Wanfang Database）、维普中文科技期刊数据库（VIP）关于应用ACDR与ACDF治疗双节段颈椎病的随机对照试验（randomized controlIed trials，RCT）及队列研究（cohort study）的文献，纳入文献的方法学质量采用改良Jadad量表及MINORS量表评价，提取各研究中术后24个月、48个月、60个月时的颈部功能障碍指数（NDI）评分、颈痛VAS评分、上肢痛VAS评分、SF-36评分、神经功能改善率、邻近节段椎间盘退变、再手术率、不良事件、患者满意度数据，并将这些研究的数据通过Review Manager 5.3软件进行Meta分析。结果：共纳入9篇文献、2570例患者，随访时间24~60个月，ACDR组1601例，ACDF组969例。纳入文献改良Jadad评4分3篇，3分4篇；MINORS评分18分2篇。Meta分析结果显示：术后24个月、48个月、60个月随访时，ACDR组的NDI[SMD=0.52；95%CI：（0.43，0.62），P＜0.00001]、颈痛VAS[SMD=0.19；95%CI：（0.10，0.29），P＜0.0001]、上肢痛VAS[SMD=0.15；95%CI：（0.06，0.25），P=0.002]、SF-36生理健康评分（PCS）[SMD=0.35；95%CI：（0.25，0.44），P＜0.00001]改善均优于ACDF组；神经功能改善率[RR=1.01；95%CI：（0.97，1.05），P=0.54]两组比较无统计学差异；两组上位椎间盘退变[RR=0.43；95%CI：（0.37，0.51），P＜0.00001]、下位椎间盘退变[RR=0.35；95%CI：（0.19，0.66），P=0.001]、再手术率[RR=0.30；95%CI：（0.23，0.40），P＜0.00001]、不良事件发生率[RR=0.72；95%CI：（0.58，0.89），P=0.003]、满意度[RR=1.08；95%CI：（1.04，1.11），P＜0.0001]比较差异均有统计学意义，ACDR组均优于ACDF组。结论：ACDR和ACDF治疗双节段颈椎病在改善神经功能方面一致，但在提高患者术后生活质量、减少手术相关并发症方面，前者优于后者。

英文摘要:

  【Abstract】 Objectives: To systematically assess the clinical effectiveness and safety of anterior cervical artificial disc replacement(ACDR) versus anterior cervical decompression and fusion(ACDF) for bi-level cervical spondylosis. Methods: According to the computer-based online search of PubMed, Embase, Medline, Cochrane Library, CBM, CNKI, Wanfang Database and VIP, the articles published before May lst, 2016 were searched. Articles designed for randomized controlled trials(RCT) and cohort study about ACDR compared with ACDF for bi-level cervical spondylosis, RCT and cohort studies were included. The quality score of methodology was assessed by Jadad and MINORS. Two authors independently assessed trial quality and extracted data． Data of neck disability index(NDI) score, VAS neck and arm pain, SF-36 score, neurological success, adjacent-segment degeneration, subsequent surgical intervention, adverse events, patient satisfaction at 24mo, 48mo, 60mo after operation from those studies were abstracted and synthesized by Review Manager 5.3 for Meta-analysis. Reasults: 7 RCT and 2 cohort studies with a total of 2570 patients were included(1601 in the ACDR group and 969 in the ACDF group, with 24mo, 48mo, 60mo follow-up). The methodological quality score of 7 RCT studies included in the Meta-analysis was from 3 to 4, 2 cohort studies was 18. Compared with ACDF, ACDR had batter NDI[SMD=0.52; 95%CI: (0.43, 0.62), P<0.00001], VAS neck[SMD=0.19; 95%CI: (0.10, 0.29), P<0.0001], VAS arm[SMD=0.15; 95%CI: (0.06, 0.25), P=0.002], SF-36 physical component summary scores(PCS)[SMD=0.35; 95%CI: (0.25, 0.44), P<0.00001]. Meta-analysis indicated that no differences were found in the rate of neurologic success[RR=1.01; 95%CI: (0.97, 1.05), P=0.54]. The ACDR of superior levels adjacent-segment degeneration [RR=0.43; 95%CI: (0.37, 0.51), P<0.00001], inferior levels adjacent-segment degeneration[RR=0.35; 95%CI: (0.19, 0.66), P=0.001], subsequent surgical intervention[RR=0.30; 95%CI: (0.23, 0.40), P<0.00001], adverse events[RR=0.72; 95%CI: (0.58, 0.89), P=0.003], patient satisfaction[RR=1.08; 95%CI: (1.04, 1.11), P<0.0001] had lower incident rate compared with ACDF at 24mo, 48mo, 60mo. Conclusions: for bi-level cervical spondylosis, ACDR was consistent with ACDF in improvement of neurologic success, however, in improvement of quality of life, reduction of the operative complications, the former is superior to the latter.