椎板成形术与前路减压融合术治疗多节段颈椎病的Meta分析
摘要
目的系统评价椎板成形术(LAMP)与颈椎前路减压融合术(ADF)治疗多节段脊髓型颈椎病的疗效。方法计算机检索EMBASE、PubMed、The Cochrane library数据库收集LAMP与ADF治疗多节段脊髓型颈椎病的临床对照试验的文献,并评价纳入研究的方法学质量。采用Cochrane协作网提供的RevMan5.1软件对JOA改善率、手术时间及术中出血量进行Meta分析。结果纳入LAMP与ADF治疗多节段脊髓型颈椎病的临床对照试验文献7篇,其中前瞻性临床对照试验3篇,回顾性对照试验4篇,共433例,LAMP234例,ADF199例。Meta分析显示:LAMP组与ADF组JOA改善率无明显差异(SMD=-0.27,95%CI为-0.65～1.10),而手术时间(SMD=-1.39,95%CI为-2.16～-0.0.62)及术中出血量(-0.63,95%CI为-1.04～-0.33)有明显差异。结论此次Meta分析发现,对于治疗多节段脊髓型颈椎病,LAMP与ADF相比较,在3年以上随访的JOA改善率无明显统计学差异,但手术时间短,出血量少。
引文
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[3]Ryken TC,Heary RF,Matz PG,et al.Cervical lam-inectomy for the treatment of cervical degenerativemyelopathy.J Neurosurg Spine,2009,11(2):142-149.
[4]Wang SJ,Jiang SD,Jiang LS,et al.Axial pain afterposterior cervical spine surgery:a systematic review.Eur Spine J,2011,20(2):185-194.
[5]Xu J,Zhang K,Ma Xin,et al.Systematic review ofcohort studies comparing surgical treatment for multi-level ossification of posterior longitudinal ligament:anterior vs posterior approach.Orthopedics,2011,34(8):e397-402.
[6]Cheng SC,Yen CH,Kwok TK,et al.Anterior spi-nal fusion versus laminoplasty for cervical spondyloticmyelopathy:a retrospective review.J Orthop Surg(Hong Kong),2009,17(3):265-268.
[7]Edwards CC2nd,Heller JG,Murakami H.Corpec-tomy versus laminoplasty for multilevel cervical my-elopathy:an independent matched-cohort analysis.Spine,2002,27(11):1168-1175.
[8]Herkowitz HN.A comparison of anterior cervical fu-sion,cervical laminectomy,and cervical laminoplastyfor the surgical management of multiple level spondy-lotic radiculopathy.Spine,1988,13(7):774-780.
[9]Lee SH,Ahn Y,Lee JH.Laser-assisted anterior cer-vical corpectomy versus posterior laminoplasty forcervical myelopathic patients with multilevel ossifica-tion of the posterior longitudinal ligament.PhotomedLaser Surg,2008,26(2):119-127.
[10]Liu T,Yang HL,Xu YZ,et al.ACDF with the PCBcage-plate system versus laminoplasty for multilevelcervical spondylotic myelopathy.J Spinal DisordTech,2011,24(4):213-220.
[11]Morimoto T,Uranishi R,Nakase H,et al.Extensivecervical laminoplasty for patients with long segmentOPLL in the cervical spine:an alternative to the ante-rior approach.J Clin Neurosci,2000,7(3):217-222.
[12]Uchida K,Nakajima H,Sato R,et al.Cervical spon-dylotic myelopathy associated with kyphosis or sagit-tal sigmoid alignment:outcome after anterior or pos-terior decompression.J Neurosurg Spine,2009,11(5):521-528.
[13]Hirai T,Okawa A,Arai Y,et al.Middle-term re-sults of a prospective comparative study of anteriordecompression with fusion and posterior decompres-sion with laminoplasty for the treatment of cervicalspondylotic myelopathy.Spine,2011,36(23):1940-1947.
[14]Koakutsu T,Morozumi N,Ishii Y,et al.Anteriordecompression and fusion versus laminoplasty for cer-vical myelopathy caused by soft disc herniation:aprospective multicenter study.J Orthop Sci,2010,15(1):71-78.
[15]Sakai K,Okawa A,Takahashi M,et al.Five-yearfollow-up evaluation of surgical treatment for cervicalmyelopathy caused by ossification of the posteriorlongitudinal ligament:a prospective comparativestudy of anterior decompression and fusion with float-ing method versus laminoplasty.Spine,2012,37(5):367-376.
[16]Sakaura H,Hosono N,Mukai Y,et al.Long-termoutcome of laminoplasty for cervical myelopathy dueto disc herniation:a comparative study of laminoplas-ty and anterior spinal fusion.Spine,2005,30(7):756-759.
[17]Shibuya S,Komatsubara S,Oka S,et al.Differencesbetween subtotal corpectomy and laminoplasty forcervical spondylotic myelopathy.Spinal Cord,2010,48(3):214-220.
[18]Wada E,Suzuki S,Kanazawa A,et al.Subtotal cor-pectomy versus laminoplasty for multilevel cervicalspondylotic myelopathy:a long-term follow-up studyover 10 years.Spine,2001,26(13):1443-1447,1448.
[19]Yonenobu K,Hosono N,Iwasaki M,et al.Lamin-oplasty versus subtotal corpectomy.A comparativestudy of results in multisegmental cervical spondyloticmyelopathy.Spine,1992,17(11):1281-1284.