零切迹椎间融合器与钛板椎间融合器治疗多节段颈椎病的Meta分析

A Meta-analysis of Zero-profile versus cage-plate interbody fusion system in anterior cervical discectomy and fusion for the treatment of multilevel cervical spondylosis

中文关键词:  零切迹椎间融合器  cage+钛板  颈椎前路减压融合术  多节段颈椎病  Meta分析

英文关键词:Zero-profile  Cage-plate  ACDF  Multilevel cervical spondylotic  Meta-analysis

中文摘要:

  【摘要】 目的：比较零切迹椎间融合器（Zero-p）与椎间融合器联合钛板固定（cage-plate）治疗多节段颈椎病（multilevel cervical spondylotic）临床疗效、放射学结果及并发症情况。方法：计算机检索中国知网、万方数据库、中国生物医学文献数据库、PubMed, Ovid，Medline数据库。中文关键词为：“零切迹椎间融合器”、“自稳型椎间融合器”、“锚定式椎间融合器”、“钉板内固定”、“Zero-p”、“ROI-C”、“ACDF”、“颈椎前路减压融合”；英文检索词“Zero-p”、“Zero-profile”、“ROI-C”、“cage and plate”、“stand-alone anchored spacer”、“anchored cage”、‘‘anchored spacer”、“no-profile”、“ACDF”。由2名评价者严格按照纳入及排除标准进行文献筛选，收集对比Zero-p与cage联合钛板治疗多节段颈椎病的文献，并进行数据提取及质量评价。采用RevMan 5.3软件进行Meta分析，比较ACDF术中应用两种不同内固定材料治疗多节段颈椎病的临床疗效、影像学结果及并发症。结果：共纳入8篇高质量文献，共634例患者，零切迹组302例，cage+钛板组332例。Meta分析显示：零切迹组在手术时间[MD=-13.08，95% CI（-23.38，-2.78），P=0.01]、术中出血量[MD=-6.76，95% CI（-12.92，-0.61），P=0.03]与cage+钛板组比较差异具有统计学意义；两组JOA评分差异[MD=-0.14，95% CI（-0.36，0.09），P=0.23]、NDI评分差异[MD=-0.05，95% CI（-0.43，0.33），P=0.80]及手术节段融合率[RR=0.99，95% CI（0.95，1.04），P=0.78]均无统计学差异；零切迹组与cage+钛板组术后C2-7Cobb角[MD=-3.11，95% CI（-4.47，-1.74），P＜0.0001]及术后椎前软组织厚度[MD=-1.00，95% CI（-1.35，-0.65），P＜0.00001]差异有统计学意义；零切迹组术后吞咽困难发生率[RR=0.61, 95% CI（0.50，0.75），P＜0.00001]及术后影像学邻近节段退变发生率[RR=0.20，95% CI（0.06，0.66），P=0.008]均低于cage+钛板组；零切迹组术后融合器沉降发生率[RR=3.07，95% CI（1.73，5.47），P=0.0001]显著高于cage+钛板固定组。结论：两种内固定治疗多节段颈椎病的临床疗效相同，零切迹椎间融合器具有手术时间短、术中出血量少、吞咽困难及邻近节段退变发生率低等特点，但传统cage联合钛板固定在恢复颈椎生理曲度、防止融合器沉降方面更具优势。

英文摘要:

  【Abstract】 Objectives: To compare the clinical efficacy, radiological results and complications of zero-profile (Zero-p) and cage-plate interbody fusion in multilevel cervical spondylosis by meta-analysis. Methods: An extensive computer search was conducted in the database of CNKI, Wanfang, CBMdisc, PubMed, Ovid and Medline for relevant articles, with search terms of Zero-p, Zero-profile, ROI-C, cage and plate, stand-alone anchored spacer, anchored cage, anchored spacer, no-profile, and ACDF. The articles were evaluated according to the inclusion and exclusion criteria. Screening literatures, data extraction and quality assessment were conducted by two reviewers independently. Meta-analysis was conducted by using RevMan 5.3 software. Results: 8 high quality articles were eventually included into this study according to the criteria, totaling 634 patients with 302 cases in Zero-p group and 332 in cage-plate group. Meta-analysis showed there were no significant differences in JOA scores[MD=-0.14, 95% CI(-0.36, 0.09), P=0.23], NDI scores[MD=-0.05, 95% CI(-0.43, 0.33), P=0.80] and surgical level fusion rate[RR=0.99, 95% CI(0.95, 1.04), P=0.78] between the two groups. Compared with cage-plate group, Zero-p group had shorter operation time[MD=-13.08, 95% CI (-23.38, -2.78), P=0.01], less intraoperative blood loss[MD=-6.76, 95% CI(-12.92, -0.61), P=0.03], smaller C2-7 Cobb angle[MD=-3.11, 95% CI(-4.47, -1.74), P＜0.0001], thinner prevertebral soft tissue[MD=-1.00, 95% CI(-1.35, -0.65), P＜0.00001], lower incidence of dysphagia[RR=0.61, 95% CI(0.50, 0.75), P＜0.00001], lower incidence of adjacent segment degeneration[RR=0.20, 95% CI(0.06, 0.66), P=0.008] and higher subsidence rate[RR=3.07, 95% CI(1.73, 5.47), P=0.0001] in multilevel surgery. Conclusions: Both Zero-p and the cage-plate fixation have similar clinical efficacy in the treatment of multilevel cervical spondylosis. Zero-p fusion has advantages of shorter operation time, less intraoperative blood loss, lower incidence of dysphagia and adjacent segment degeneration, while traditional cage-plate fixation is better at restoring cervical curvature and preventing cage subsidence.