单开门椎管扩大成形术与全椎板切除减压融合术治疗多节段颈椎后纵韧带骨化症疗效的Meta分析

A meta-analysis of the efficacies of laminoplasty versus laminectomy and fusion in the treatment of multi-level ossification of the posterior longitudinal ligament in the cervical spine

中文关键词:  多节段颈椎后纵韧带骨化症  单开门椎管扩大成形术  全椎板切除减压融合术  Meta分析

英文关键词:Multi-level ossification of the posterior longitudinal ligament in the cervical spine  Laminoplasty  Laminectomy and fusion  Meta-analysis

中文摘要:

  【摘要】 目的：通过Meta分析评价单开门椎管扩大成形术（laminoplasty，LP）与全椎板切除减压融合术（laminectomy and fusion，LF）治疗多节段颈椎后纵韧带骨化症（ossification of posterior longitudinal ligament，OPLL）的临床疗效。方法：计算机检索中国知网、万方数据库、Pubmed、Cochrane Library、EMBASE等数据库自建库起至2023年6月公开发表的对比LP与LF治疗多节段颈椎OPLL疗效的临床研究。运用Cochrane风险偏倚评估工具和纽卡斯尔-渥太华量表（Newcastle-Ottawa Scale，NOS）评价纳入研究的质量，提取相关数据，包括手术时间、术中出血量、末次随访时日本骨科协会（Japanese Orthopaedic Association，JOA）评分较术前的改善率、视觉模拟量表（visual analogue scale，VAS）评分及颈椎功能障碍指数（neck disability index，NDI）较术前的改变值、末次随访时颈椎曲度指数（cervical curvature index，CCI）、颈椎矢状面轴向距离（sagittal vertical axis，SVA）、颈椎矢状面活动度（cervical range of motion，CROM）较术前的改变值、术后并发症发生率及OPLL进展率。整理数据后应用RevMan 5.4及StataSE 16.0软件完成Meta分析。结果：共纳入12篇文献，包括3篇随机对照研究，9篇队列研究，样本总量1496例，其中LP组患者839例，LF组患者657例。Meta分析结果显示，手术时间[WMD=-28.01，95%CI（-36.25，-19.77），P<0.00001]、术中出血量[WMD=-115.09，95%CI（-197.91，-32.27），P=0.006]、末次随访时较术前的CROM改变值[WMD=-7.83，95%CI（-8.10，-7.55），P<0.00001]、术后C5神经根麻痹发生率[OR=0.32，95%CI（0.21，0.50），P<0.00001]、术后轴性症状发生率[OR=0.44，95%CI（0.28，0.71），P=0.0006]两组间差异有统计学意义，LP组优于LF组。末次随访时较术前的CCI改变值[WMD=-0.75，95%CI（-0.92，-0.58），P<0.00001]、SVA改变值[WMD=5.49，95%CI（5.30，5.68），P<0.00001]，术后OPLL进展率[OR=1.76，95%CI（1.26，2.46），P=0.0009]，两组间差异亦有统计学意义，LF组优于LP组。末次随访时较术前的JOA评分改善率[WMD=-1.24，95%CI（-4.02，1.54），P=0.38]、VAS评分改变值[WMD=0.03，95%CI（-0.43，0.49），P=0.89]、NDI改变值[WMD＝0.54，95%CI（-0.07，1.14），P=0.08]、术后脑脊液漏发生率[OR=0.58，95%CI（0.24，1.39），P=0.22]、术后切口感染发生率[OR=0.71，95%CI（0.32，1.57），P=0.39]、术后硬膜外血肿发生率[OR=0.37，95%CI（0.06，2.16），P=0.27]，两组间差异无统计学意义。结论：LF和LP两种手术策略均能有效治疗多节段颈椎OPLL、改善患者神经功能。与LF相比，LP创伤小，术后能保留更多的颈椎活动度，且C5神经根麻痹和轴性症状发生率更低，而LF能更好地维持术后颈椎的曲度与稳定性，并延缓骨化物进展。

英文摘要:

  【Abstract】 Objectives: To evaluate the efficacies of laminoplasty(LP) and laminectomy and fusion(LF) in the treatment of multi-level ossification of the posterior longitudinal ligament(OPLL) in the cervical spine through meta-analysis. Methods: The databases of CNKI, Wanfang, Pubmed, Cochrane Library, EMBASE were searched by computer from their inceptions to June 2023 and the published clinical studies comparing LP and LF in the treatment of multi-level OPLL in the cervical spine were included. Cochrane risk bias assessment tool and Newcastle-Ottawa scale(NOS) were used to evaluate the quality of the included studies. Relevant data including operation time, intraoperative blood loss, the improvement rate of Japanese Orthopaedic Association(JOA) score, the change value of visual analogue scale(VAS) score, neck disability index(NDI), cervical curvature index(CCI), sagittal vertical axis(SVA) and cervical range of motion(CROM) at the final follow-up, the postoperative complication rate and OPLL progression rate were extracted and sorted. Then the meta-analysis was conducted by RevMan 5.4 and StataSE 16.0 softwares. Results: 12 literatures(3 randomized controlled studies and 9 cohort studies) were ultimately included, involving a total sample size of 1496 cases, containing 839 cases in the LP group and 657 cases in the LF group. The results of meta-analysis were as follows: the LP group was better than LF group with significant differences in operation time[WMD=-28.01, 95%CI(-36.25,-19.77), P<0.00001], intraoperative blood loss[WMD=-115.09, 95%CI(-197.91, -32.27), P=0.006], the change value of CROM[WMD=-7.83, 95%CI(-8.10, -7.55), P<0.00001] compared with those before surgery at final follow-up, the incidence of postoperative C5 nerve root paralysis[OR=0.32, 95%CI(0.21, 0.50), P<0.00001] and axial symptoms[OR=0.44, 95%CI(0.28, 0.71), P=0.0006]. The LF group was better than the LP group with significant differences in the change value of the CCI[WMD=-0.75, 95%CI(-0.92, -0.58), P<0.00001] and SVA[WMD=5.49, 95%CI(5.30, 5.68), P<0.00001] compared with those before surgery at final follow-up, and the postoperative OPLL progression rate[OR=1.76, 95%CI(1.26, 2.46), P=0.0009]. There were no significant differences between the two groups in the improvement rate of JOA score[WMD=-1.24, 95%CI(-4.02, 1.54), P=0.38], the change value of VAS[WMD=0.03, 95%CI(-0.43, 0.49), P=0.89] and NDI[WMD＝0.54, 95%CI(-0.07, 1.14), P=0.08] compared with those before surgery at final follow-up, the incidence of postoperative cerebrospinal fluid leakage[OR=0.58, 95%CI(0.24, 1.39), P=0.22], incision infection[OR=0.71, 95%CI(0.32, 1.57), P=0.39] and epidural hematoma[OR=0.37, 95%CI(0.06, 2.16), P=0.27]. Conclusions: Both LF and LP can effectively treat multi-level OPLL in the cervical spine and improve the neurological function of patients. Compared to LF, LP causes less surgical damage, preserves more cervical mobility and additionally, has a lower incidence of the postoperative C5 nerve root paralysis and axial symptoms. In comparison, LF can better maintain the curvature and stability of the cervical spine and delay the progression of ossification.