单开门椎管扩大成形术中保留单侧肌肉韧带复合体对临床疗效影响的Meta分析

Clinical outcomes effect of preserving the unilateral muscle-ligament complex in open-door laminoplasty: a Meta analysis

中文关键词:  单开门椎管扩大成形术  保留肌肉韧带复合体  Meta分析

英文关键词:Laminoplasty  Muscle-ligament complex  Meta analysis

中文摘要:

  【摘要】 目的：通过Meta分析评估单开门椎管扩大成形术中保留单侧肌肉韧带复合体对临床疗效的影响。方法：对PubMed、Web of Science、Embase、Cochrane、知网、万方、维普及CBM数据库进行检索，筛选出保留单侧肌肉韧带复合体的单开门椎管扩大成形术（改良组）与不保留单侧肌肉韧带复合体的单开门椎管扩大成形术（传统组）临床疗效的对比研究。统计各研究中手术时间、术中出血量，术后1年疼痛视觉模拟（visual analogue scale，VAS）评分、颈椎功能障碍指数（neck disability index，NDI）、轴性疼痛发生率、颈椎活动度、颈椎矢状位垂直距离（sagittal vertical axis，cSVA）、C5神经根麻痹发生率、日本骨科协会（Japanese Orthopaedic Association，JOA）评分以及术后2年内颈椎曲度指数等指标。置信区间（confidence interval，CI）取95%，对于二分类变量型数据选用比值比（odds ratio，OR），对于连续性变量型数据选用标准化均数差（standardized mean difference，SMD）作为合并统计量。通过Revman 5.3.0进行分析，评价改良单开门椎管扩大成形术的优劣。结果：最终共11篇文献，905例患者纳入本研究。其中改良组手术时间[SMD=1.06，95%CI（0.20，1.92），P=0.02]较长，术中出血量[SMD=0.56，95%CI（0.40，1.09），P=0.04]较多，但术后1年VAS评分[SMD=-1.39，95%CI（-1.98,-0.80），P=0.00001]、NDI[SMD=-0.51，95%CI（-0.69，-0.33），P<0.00001]、术后1年轴性疼痛的发生率[OR=0.42，95%CI（0.26，0.67），P=0.003]均小于传统组。改良组术后1年颈椎活动度[SMD=0.85，95%CI（0.64，1.06），P<0.00001]大于传统组，术后1年cSVA[SMD=-2.33，95%CI（-3.84，-0.81），P=0.003]小于传统组；两组间术后1年C5神经根麻痹的发生率[OR=0.44，95%CI（0.18，1.06），P=0.07]和术后1年JOA评分[SMD=0.09，95%CI（-0.22，0.40），P=0.58]无统计学差异。改良组术后2年颈椎曲度指数[SMD=0.96，95%CI（0.68，1.24），P<0.00001]大于传统组。结论：保留单侧肌肉韧带复合体的改良单开门术式在减少患者术后轴性疼痛的发生、保护颈椎活动功能及维持正常矢状位序列等方面均具有一定的优势，但相对于传统组而言其手术时间更长，术中出血量也更多。

英文摘要:

  【Abstract】 Objectives: To explore the clinical effect of modified laminoplasty with preservation of unilateral muscle-ligament complex using Meta-analysis. Methods: The databases of PubMed, Web of Science, Embase, Cochrane, CNKI(China National Knowledge Infrastructure), Wanfang, Weipu, and CBM CBM were searched, and studies of laminoplasty that preserved the unilateral muscle and ligament complex(modified group) and of laminoplasty that did not preserve the unilateral muscle and ligament(traditional group) were screened out. The postoperative VAS score, postoperative cervical spine dysfunction index(neck disability index, NDI), the incidence of postoperative axial pain, postoperative cervical curvature index, postoperative cervical spine mobility,postoperative cervical sagittal vertical distance(cSVA), postoperative C5 nerve root paralysis, postoperative JOA score and other indicators were recorded. The extracted data was analyzed by Revman 5.3.0. Among them, we used the odds ratio(OR) as the synthetic statistics for the binary variable data, and the standardized mean difference(SMD) as the synthetic statistics for the continuous variable data. Finally, the pros and cons of the modified group were evaluated by the above. Results: In the end, a total of 11 articles and a total of 905 patients were included in this study. The operation time of the modified group[SMD=1.06, 95%CI(0.20, 1.92), P=0.02] was longer, intraoperative blood loss[SMD=0.56, 95%CI(0.40, 1.09), P=0.04] was more. Of the modified group, the postoperative VAS score one year later[SMD=-1.39, 95%CI(-1.98, -0.80), P=0.00001] and NDI score[SMD=-0.51, 95%CI(-0.69, -0.33), P<0.00001] were smaller than those of the traditional group, and the incidence rates of postoperative axial pain one year later[OR=0.42, 95%CI(0.26, 0.67), P=0.003] was lower. Besides, the postoperative cervical curvature index two years later[SMD=0.96, 95%CI(0.68, 1.24), P<0.00001], and cervical spine mobility one year later[SMD=0.85, 95%CI(0.64, 1.06), P<0.00001] of the modified group was greater than those of the traditional group, while cSVA one year later[SMD=-2.33, 95%CI(-3.84, -0.81), P=0.003] was shorter than the latter. The incidence of C5 nerve root paralysis one year later be`tween the two groups[OR=0.44, 95%CI(0.18, 1.06), P=0.07] and postoperative JOA score one year later[SMD=0.09, 95%CI(-0.22, 0.40), P=0.58] showed no statistical difference. Conclusions: The modified operation that preserves the unilateral muscle-ligament complex has certain advantages in reducing the incidence of postoperative axial pain, protecting the cervical spine movement function, and maintaining the normal sagittal sequence, however, compared with the traditional group, the operation time is longer and the intraoperative blood loss is more.