C_3椎板切除与C_3椎板成形治疗多节段脊髓型颈椎病的Meta分析
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摘要
背景:针对颈椎后路单开门椎管扩大成形术,C3椎板2种处理方式(C3椎板切除与C3椎板成形)的临床效果以及对术后颈椎功能的影响如何,相关客观评价较少,为此进行了此项研究。目的:系统评价颈椎后路椎管扩大成形术中C3椎板切除与C3椎板成形治疗多节段脊髓型颈椎病的疗效。方法:计算机检索Cochrane Central、PubMed、EMbase、the ISI Web of Knowledge Database、CNKI、CMB、维普、万方数据库,检索时间均为建库时间至2018-07-01。纳入关于C3椎板切除和椎板成形治疗多节段脊髓型颈椎病疗效对比的随机或非随机对照试验。Meta分析采用Cochrane协作网提供的Rev-Man5.3软件进行。结果与结论:①共纳入5个研究,316例患者,其中C3椎板切除组146例,C3椎板成形组170例;②Mate分析结果显示,在术后颈椎功能方面,与传统C3椎板成形相比,C3椎板切除术后颈椎活动度丢失较少[SMD=-5.89,95%CI(-7.25,-4.70),P <0.05]、术后轴性症状发生率低[SMD=-0.23,95%CI(0.12,0.46),P<0.05];③在神经功能恢复方面,2组术后日本骨科协会评分差异无显著性意义[SMD=-0.02,95%CI(-0.55,0.51),P=0.95> 0.05];④结果表明,采用椎管扩大成形治疗多节段脊髓型颈椎病时C3椎板的2种处理方式(椎板切除或椎板成形)均能取得较好的临床效果,但椎板切除能有效防止颈椎活动度丢失、降低术后轴性症状发生率。
BACKGROUND: There are few objective evaluations concerning efficacy of C3 laminectomy versus C3 laminoplasty in posterior cervical expansive open-door laminoplasty and their effects on cervical function.OBJECTIVE: To systematically evaluate the efficacy of C3 laminectomy versus C3 laminoplasty in posterior cervical expansive open-door laminoplasty for treating multi-segment cervical spondylotic myelopathy.METHODS: Databases of Cochrane Central, PubMed, EMbase, the ISI Web of Knowledge Database, CNKI, CBM, VIP and WanFang were searched for the articles published before July 1, 2018. Randomized or non-randomized controlled trails that compared the efficacy of C3 laminectomy and C3 laminoplasty for treating multi-segment cervical spondylotic myelopathy were included. Meta-analyses were performed on RevMan 5.2 software provided by Cochrane Collaboration.RESULTS AND CONCLUSION:(1) Five studies involving 316 patients were included. Among the patients, 146 underwent C3 laminectomy and 170 underwent C3 laminoplasty.(2) The results of meta-analysis showed that: compared with C3 laminoplasty, C3 laminectomy had higher cervical range of motion [SMD=-5.89, 95%CI(-7.25,-4.70), P < 0.05], and lower incidence of axial symptoms [SMD=-0.23, 95%CI(0.12,0.46), P < 0.05].(3) There was no significant difference between two groups in the postoperative Japanese Orthopeadic Association score[SMD=-0.02, 95%CI(-0.55, 0.51), P=0.95 > 0.05].(4) These results imply that posterior cervical laminoplasty for treating cervical spondylotic using C3 laminectomy and laminoplasty can obtain good clinical outcomes. However, laminectomy can prevent loss of cervical range of motion and reduce the incidence of axial symptoms.
BACKGROUND: There are few objective evaluations concerning efficacy of C3 laminectomy versus C3 laminoplasty in posterior cervical expansive open-door laminoplasty and their effects on cervical function.OBJECTIVE: To systematically evaluate the efficacy of C3 laminectomy versus C3 laminoplasty in posterior cervical expansive open-door laminoplasty for treating multi-segment cervical spondylotic myelopathy.METHODS: Databases of Cochrane Central, PubMed, EMbase, the ISI Web of Knowledge Database, CNKI, CBM, VIP and WanFang were searched for the articles published before July 1, 2018. Randomized or non-randomized controlled trails that compared the efficacy of C3 laminectomy and C3 laminoplasty for treating multi-segment cervical spondylotic myelopathy were included. Meta-analyses were performed on RevMan 5.2 software provided by Cochrane Collaboration.RESULTS AND CONCLUSION:(1) Five studies involving 316 patients were included. Among the patients, 146 underwent C3 laminectomy and 170 underwent C3 laminoplasty.(2) The results of meta-analysis showed that: compared with C3 laminoplasty, C3 laminectomy had higher cervical range of motion [SMD=-5.89, 95%CI(-7.25,-4.70), P < 0.05], and lower incidence of axial symptoms [SMD=-0.23, 95%CI(0.12,0.46), P < 0.05].(3) There was no significant difference between two groups in the postoperative Japanese Orthopeadic Association score[SMD=-0.02, 95%CI(-0.55, 0.51), P=0.95 > 0.05].(4) These results imply that posterior cervical laminoplasty for treating cervical spondylotic using C3 laminectomy and laminoplasty can obtain good clinical outcomes. However, laminectomy can prevent loss of cervical range of motion and reduce the incidence of axial symptoms.
引文
[1]Hale JJ,Gruson KI,Spivak JM,et al.Laminoplasty:a review of its role in compressive cervical myelopathy.Spine J.2006;6(6 Suppl):289S-298S.
[2]Matz PG,Anderson PA,Groff MW,et al.Cervical laminoplasty for the treatment of cervical degenerative myelopathy.J Neurosurg Spine.2002;11(2):157-169.
[3]Wang SJ,Jiang SD,Jiang LS,et al.Axial pain after posterior cervical spine surgery:a systematic review.Eur Spine J.2011;20(2):185-194.
[4]Imagama S,Matsuyama Y,Yukawa Y,et al.C5 palsy after cervical laminoplasty:a multicentre study.J Bone Joint Surg Br.2010;92(3):393-400.
[5]Takeuchi K,Yokoyama T,Ono A,et al.Limitation of activities of daily living accompanying reduced neck mobility after laminoplasty preserving or reattaching the semispinalis cervicis into axis.Eur Spine J.2008;17(3):393-400.
[6]Takeuchi K,Yokoyama T,Aburakawa S,et al.Axial symptoms after cervical laminoplasty with C3 laminectomy compared with conventional C3-C7 laminoplasty.Spine J.2005;30(22):2544-2549.
[7]Gore DR,Sepic SB,Gardner GM.Roentgenographic findings of the cervical spine in asymptomatic.Spine.1986;11(6):521-524.
[8]Wells GA,Shea BJ,O’Connel L,et al.The Newcastle-Ottawa Scale(NOS)for assessing the quality of nonrandomized studies in meta-analyses.Appl Eng Agric.2008;18(6):727-734.
[9]张为,陈白成,申勇,等.C3椎板切除单开门成形术对颈椎轴性症状的影响[J].中华骨科杂志,2006,26(8):544-548.
[10]杨宝林,张绍东,王小虎,等.颈椎后路改良单开门扩大成形术治疗多节段脊髓型颈椎病的疗效分析[J].中国脊柱脊髓杂志,2018,28(4):289-296.
[11]Lee GW,Cho CW,Shin JH,et al.Which technique is better option for C3 segment in multi-level open-door Laminoplasty of the cervical spine:Laminectomy versus Laminoplasty.Spine(Phila Pa1976).2017;42(14):E833-E840.
[12]Lee DH,Cho JH,Hwang CJ,et al.Can C3 laminectomy reduce interlaminar bony fusion and preserve the range of motion after cervical laminoplasty?Spine(Phila Pa 1976).2016;41(24):1884-1890.
[13]陈仲强,主编.脊柱外科学[M].北京:人民卫生出版社,2013:261-266.
[14]Hirabayashi K,Watanabe K,Wakano K,et al.Expansive open door laminoplasty for cervical spinal stenotic myelopathy.Spine J.1983;8(7):693-699.
[15]Steinmetz MP,Resnick DK.Cervical laminoplasty.Spine J.2006;6(6 Suppl):274S-281S.
[16]Duetzmann S,Cole T,Cole T,et al.Cervical laminoplasty developments and trends,2003-2013:a systematic review.JNeurosurg Spine.2015;23(1):24-34.
[17]John M,Rhee MD,Bradley R,et al.Plate-only open door laminoplasty maintains stable spinal canal expansion with high rates of hing union and no plate failures.Spine J.2012;36(1):9-14.
[18]刘晓伟,陈德玉,王波,等.C3-C7与C3-C6节段单开门椎管扩大成形术后轴性痛的差异[J].中国脊柱脊髓杂志,2012,22(11):989-993.
[19]Duetzmann S,Cole T,Ratliff JK.Cervical laminoplasty developments and trends,2003-2013:a systematic review.JNeurosurg Spine.2015;23(1):24-34.
[20]何保华,朱伟,夏虹,等.改良与传统椎管扩大成形术治疗多节段脊髓型颈椎病的疗效比较[J].中国骨与关节损伤杂志,2017,32(11):1167-1169.
[21]Heller JG,Edwards CC,Murakami H,et al.Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy:an independent matched-cohort analysis.Spine.2001;26(12):1330-1336.
[22]刘金锐,杨庆国.单开门颈椎馆扩大成形术的术式及并发症的研究进展[J].颈腰痛杂志,2012,33(2):135-138.
[23]安忠诚,曹瑞,盛伟斌,等.保留双侧半棘肌改良单开门椎管扩大钢板置入:减少轴性症状及颈椎曲度丢失[J].中国组织工程研究,2016,20(13):1873-1879.
[24]Yeh KT,Chen IH,Yu TC,et al.Modified expansive open door laminoplasty technique improved postoperative neck pain and cervical range of motion.J Formos Med Assoc.2015;114(12):1225-1232.
[25]Riew KD,Raich AL,Dettori JR,et al.Neck pain following cervical laminoplasty:does preservation of C2 muscle attachments and/or C7 matter.Evid Based Spine Care J.2013;4(1):42-53.
[26]Schulz KF,Moher D,Altman DG.CONSORT 2010 comments.Lancet.2010;376(9748):1222-1223.
[2]Matz PG,Anderson PA,Groff MW,et al.Cervical laminoplasty for the treatment of cervical degenerative myelopathy.J Neurosurg Spine.2002;11(2):157-169.
[3]Wang SJ,Jiang SD,Jiang LS,et al.Axial pain after posterior cervical spine surgery:a systematic review.Eur Spine J.2011;20(2):185-194.
[4]Imagama S,Matsuyama Y,Yukawa Y,et al.C5 palsy after cervical laminoplasty:a multicentre study.J Bone Joint Surg Br.2010;92(3):393-400.
[5]Takeuchi K,Yokoyama T,Ono A,et al.Limitation of activities of daily living accompanying reduced neck mobility after laminoplasty preserving or reattaching the semispinalis cervicis into axis.Eur Spine J.2008;17(3):393-400.
[6]Takeuchi K,Yokoyama T,Aburakawa S,et al.Axial symptoms after cervical laminoplasty with C3 laminectomy compared with conventional C3-C7 laminoplasty.Spine J.2005;30(22):2544-2549.
[7]Gore DR,Sepic SB,Gardner GM.Roentgenographic findings of the cervical spine in asymptomatic.Spine.1986;11(6):521-524.
[8]Wells GA,Shea BJ,O’Connel L,et al.The Newcastle-Ottawa Scale(NOS)for assessing the quality of nonrandomized studies in meta-analyses.Appl Eng Agric.2008;18(6):727-734.
[9]张为,陈白成,申勇,等.C3椎板切除单开门成形术对颈椎轴性症状的影响[J].中华骨科杂志,2006,26(8):544-548.
[10]杨宝林,张绍东,王小虎,等.颈椎后路改良单开门扩大成形术治疗多节段脊髓型颈椎病的疗效分析[J].中国脊柱脊髓杂志,2018,28(4):289-296.
[11]Lee GW,Cho CW,Shin JH,et al.Which technique is better option for C3 segment in multi-level open-door Laminoplasty of the cervical spine:Laminectomy versus Laminoplasty.Spine(Phila Pa1976).2017;42(14):E833-E840.
[12]Lee DH,Cho JH,Hwang CJ,et al.Can C3 laminectomy reduce interlaminar bony fusion and preserve the range of motion after cervical laminoplasty?Spine(Phila Pa 1976).2016;41(24):1884-1890.
[13]陈仲强,主编.脊柱外科学[M].北京:人民卫生出版社,2013:261-266.
[14]Hirabayashi K,Watanabe K,Wakano K,et al.Expansive open door laminoplasty for cervical spinal stenotic myelopathy.Spine J.1983;8(7):693-699.
[15]Steinmetz MP,Resnick DK.Cervical laminoplasty.Spine J.2006;6(6 Suppl):274S-281S.
[16]Duetzmann S,Cole T,Cole T,et al.Cervical laminoplasty developments and trends,2003-2013:a systematic review.JNeurosurg Spine.2015;23(1):24-34.
[17]John M,Rhee MD,Bradley R,et al.Plate-only open door laminoplasty maintains stable spinal canal expansion with high rates of hing union and no plate failures.Spine J.2012;36(1):9-14.
[18]刘晓伟,陈德玉,王波,等.C3-C7与C3-C6节段单开门椎管扩大成形术后轴性痛的差异[J].中国脊柱脊髓杂志,2012,22(11):989-993.
[19]Duetzmann S,Cole T,Ratliff JK.Cervical laminoplasty developments and trends,2003-2013:a systematic review.JNeurosurg Spine.2015;23(1):24-34.
[20]何保华,朱伟,夏虹,等.改良与传统椎管扩大成形术治疗多节段脊髓型颈椎病的疗效比较[J].中国骨与关节损伤杂志,2017,32(11):1167-1169.
[21]Heller JG,Edwards CC,Murakami H,et al.Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy:an independent matched-cohort analysis.Spine.2001;26(12):1330-1336.
[22]刘金锐,杨庆国.单开门颈椎馆扩大成形术的术式及并发症的研究进展[J].颈腰痛杂志,2012,33(2):135-138.
[23]安忠诚,曹瑞,盛伟斌,等.保留双侧半棘肌改良单开门椎管扩大钢板置入:减少轴性症状及颈椎曲度丢失[J].中国组织工程研究,2016,20(13):1873-1879.
[24]Yeh KT,Chen IH,Yu TC,et al.Modified expansive open door laminoplasty technique improved postoperative neck pain and cervical range of motion.J Formos Med Assoc.2015;114(12):1225-1232.
[25]Riew KD,Raich AL,Dettori JR,et al.Neck pain following cervical laminoplasty:does preservation of C2 muscle attachments and/or C7 matter.Evid Based Spine Care J.2013;4(1):42-53.
[26]Schulz KF,Moher D,Altman DG.CONSORT 2010 comments.Lancet.2010;376(9748):1222-1223.