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[1]羅金峰,秋曙祎,王志民,等.頸椎后路單開(kāi)門椎管擴(kuò)大成形跳躍式與連續(xù)性微型鈦板固定治療多節(jié)段脊髓型頸椎病的Meta分析[J].中醫(yī)正骨,2023,35(10):31-36.
　LUO Jinfeng,QIU Shuyi,WANG Zhimin,et al.Mini-titanium plates alternative-level versus all-level fixation in unilateral open-door laminoplasty through cervical posterior approach for treatment of multisegment cervical spondylotic myelopathy:a meta-analysis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2023,35(10):31-36.
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頸椎后路單開(kāi)門椎管擴(kuò)大成形跳躍式與連續(xù)性微型鈦板固定治療多節(jié)段脊髓型頸椎病的Meta分析()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第35卷
期數(shù):
2023年10期
頁(yè)碼:
31-36
欄目:
文獻(xiàn)研究
出版日期:
2023-10-20

文章信息/Info

Title:
Mini-titanium plates alternative-level versus all-level fixation in unilateral open-door laminoplasty through cervical posterior approach for treatment of multisegment cervical spondylotic myelopathy:a meta-analysis
作者:
羅金峰1; 秋曙祎1; 王志民1; 王太紅2
1.河南中醫(yī)藥大學(xué)第一附屬醫(yī)院,河南 鄭州 450000; 2.商丘市中醫(yī)院,河南 商丘 476000
Author(s):
LUO Jinfeng1; QIU Shuyi1; WANG Zhimin1; WANG Taihong2
1.The First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450000,Henan,China 2.Shangqiu Hospital of Traditional Chinese Medicine,Shangqiu 476000,Henan,China
關(guān)鍵詞:
椎板成形術(shù);  脊髓型頸椎病;  骨板;  跳躍式固定;  連續(xù)性固定;  專題Meta分析
Keywords:
laminoplasty;  cervical spondylotic myelopathy;  bone plates;  alternative-level fixation;  all-level fixation;  meta-analysis as topic
摘要:
目的:系統(tǒng)評(píng)價(jià)頸椎后路單開(kāi)門椎管擴(kuò)大成形跳躍式與連續(xù)性微型鈦板固定治療多節(jié)段脊髓型頸椎病(cervical spondylotic myelopathy,CSM)的優(yōu)劣。方法:通過(guò)計(jì)算機(jī)檢索中國(guó)知網(wǎng)、萬(wàn)方數(shù)據(jù)庫(kù)、維普網(wǎng)、中國(guó)生物醫(yī)學(xué)文獻(xiàn)服務(wù)系統(tǒng)、PubMed、Web of Science、Embase、Cochrane Library中有關(guān)頸椎后路單開(kāi)門椎管擴(kuò)大成形跳躍式與連續(xù)性微型鈦板固定治療多節(jié)段CSM對(duì)比研究的文獻(xiàn),檢索時(shí)限均為建庫(kù)至2022年11月10日。跳躍固定組和連續(xù)固定組分別采用頸椎后路單開(kāi)門椎管擴(kuò)大成形跳躍式與連續(xù)性微型鈦板固定治療。由2名研究人員獨(dú)立篩選文獻(xiàn)、提取數(shù)據(jù)并評(píng)價(jià)納入研究的偏倚風(fēng)險(xiǎn)后,采用RevMan5.4軟件進(jìn)行Meta分析。結(jié)果:共納入12項(xiàng)研究,其中非隨機(jī)干預(yù)性研究11項(xiàng)、隨機(jī)對(duì)照試驗(yàn)1項(xiàng); 共涉及1037例患者,其中跳躍固定組528例、連續(xù)固定組509例。Meta分析結(jié)果顯示,2組患者末次隨訪時(shí)日本骨科學(xué)會(huì)評(píng)分、神經(jīng)功能改善率、術(shù)后頸椎曲度、術(shù)后頸椎活動(dòng)度、C5神經(jīng)根麻痹和軸性癥狀發(fā)生率、住院時(shí)間的組間差異均無(wú)統(tǒng)計(jì)學(xué)意義; 與連續(xù)固定組相比,跳躍固定組的手術(shù)時(shí)間更短[SMD=-0.33,95%CI(-0.57,-0.08)]、術(shù)中出血量更少[SMD=-0.29,95%CI(-0.50,-0.09)]、住院費(fèi)用更低[SMD=-5.42,95%CI(-7.07,-3.78)]。11項(xiàng)研究報(bào)告了再關(guān)門現(xiàn)象,至末次隨訪時(shí)2組均未發(fā)生再關(guān)門現(xiàn)象; 其中2項(xiàng)研究比較了跳躍固定組未使用鈦板固定節(jié)段與連續(xù)固定組對(duì)應(yīng)節(jié)段末次隨訪時(shí)的椎板開(kāi)口角度,Meta分析結(jié)果顯示跳躍固定組對(duì)應(yīng)節(jié)段的椎板開(kāi)口角度小于連續(xù)固定組[MD=-2.57,95%CI(-3.34,-1.81),P=0.000]。針對(duì)末次隨訪時(shí)日本骨科學(xué)會(huì)評(píng)分的漏斗圖基本對(duì)稱,提示存在發(fā)表偏倚的可能性較小。結(jié)論:現(xiàn)有的證據(jù)表明,頸椎后路單開(kāi)門椎管擴(kuò)大成形跳躍式與連續(xù)性微型鈦板固定治療多節(jié)段CSM的療效和安全性相當(dāng),但跳躍式微型鈦板固定的手術(shù)時(shí)間更短、術(shù)中出血更少、住院費(fèi)用更低。
Abstract:
Objective:To systematically review the superiority and inferiority of mini-titanium plates alternative-level versus all-level fixation in unilateral open-door laminoplasty through cervical posterior approach for treatment of multisegment cervical spondylotic myelopathy(CSM).Methods:All the comparative study articles about mini-titanium plates alternative-level(alternative-level fixation group)versus all-level fixation(all-level fixation group)in unilateral open-door laminoplasty through cervical posterior approach for treatment of multisegment CSM included from database establishing to November 10,2022 were retrieved from China National Knowledge Internet,Wanfang Database,Vip Database,Chinese Biomedical Literature Service System,PubMed,Web of Science,Embase and Cochrane Library through computer.The patients in alternative-level fixation group and all-level fixation group were treated with mini-titanium plates alternative-level and all-level fixation in unilateral open-door laminoplasty through cervical posterior approach respectively.The articles were screened and the information was extracted independently by two researchers according to the inclusion and exclusion criteria.The methodological quality of research in the articles was evaluated respectively independently by the same two researchers,and if any disagreement was found between them,discussion was conducted for making a final decision,and then a Meta-analysis was conducted by using RevMan5.4 software.Results:Twelve articles(1037 patients)were included in the final analysis,including 11 non-randomized intervention study articles,and 1 randomized controlled trial(RCT)article.Five hundred and twenty-eight patients in alternative-level fixation group,and 509 ones in all-level fixation group.The results of Meta-analysis revealed that,at the last follow-up,there was no statistical difference in Japanese Orthopaedic Association(JOA)score,improvement rate of neurological function,postoperative cervical curvature,postoperative cervical range of motion,incidence rate of C5 nerve root palsy and axial symptoms and hospital stays between the 2 groups; while the operative time was shorter,the intraoperative blood loss and total hospitalization cost were less in alternative-level fixation group compared to all-level fixation group(SMD=-0.33,95%CI(-0.57,-0.08); SMD=-0.29,95%CI(-0.50,-0.09); SMD=-5.42,95%CI(-7.07,-3.78).The reclose of the opened laminae was reported in 11 studies,and no reclose occurred in the 2 groups at the last follow-up.The opening angle of the laminae measured at the last follow-up was compared between the segments fixed with titanium plates in all-level fixation group and the corresponding segments unfixed with titanium plates in alternative-level fixation group in 2 studies,and the results of Meta-analysis revealed that the opening angle was smaller in alternative-level fixation group compared with that of all-level fixation group(MD=-2.57,95%CI(-3.34,-1.81),P=0.000).Publication bias was analyzed according to funnel plots drawned based on JOA score measured at the last follow-up,and the essentially symmetrical funnel plots suggested that publication bias was a remote possibility.Conclusion:Available evidences suggest that mini-titanium plates alternative-level fixation in unilateral open-door laminoplasty through cervical posterior approach is similar to mini-titanium plates all-level fixation in unilateral open-door laminoplasty through cervical posterior approach in clinical outcomes and safety in treatment of multisegment CSM,while the former displays the advantages of shorter operative time,less intraoperative blood loss and total hospitalization cost compared to the latter.

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[1]王玉強(qiáng),王利民,劉屹林,等.合并后縱韌帶退變的脊髓型頸椎病的臨床及影像特征研究[J].中醫(yī)正骨,2020,32(07):6.
　WANG Yuqiang,WANG Limin,LIU Yilin,et al.A study of clinical and imaging characteristics of cervical spondylotic myelopathy combined with cervical posterior longitudinal ligament degeneration[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2020,32(10):6.
[2]段寒,譚洪宇,張楊,等.頸椎曲度與脊髓型頸椎病的關(guān)系研究[J].中醫(yī)正骨,2022,34(01):8.
　DUAN Han,TAN Hongyu,ZHANG Yang,et al.The relationship between cervical spine curvature and cervical spondylosis myelopathy:a clinical study[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(10):8.

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更新日期/Last Update: 1900-01-01