颈椎后路单开门与双开门椎管成形治疗脊髓型颈椎病的Meta分析
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摘要
背景:对于颈椎单开门及双开门椎管成形治疗脊髓型颈椎病的临床效果是否存在差异,一些研究得出相互矛盾的结论,即便关于这2种术式的Meta分析也得出了不同的结果。目的:系统评价颈椎后路单开门与双开门椎管成形治疗脊髓型颈椎病的有效性及安全性。方法:计算机检索所有关于颈椎后路单开门椎管成形与双开门椎管成形治疗脊髓型颈椎病的国内外临床试验。由2名研究人员独立进行文献筛选、数据提取和纳入文献评价,用Cochrane协作网提供的偏倚风险评估工具对纳入随机对照试验进行质量评价,以NOS量表进行回顾性研究的质量评价,使用RevM an5.3软件进行Meta分析。结果与结论:(1)共纳入14篇文献,共893例患者;(2)Meta分析结果显示:2种术式在改善脊髓型颈椎病患者目测类比评分[SMD=0.24,95%CI(-0.64,1.11),P=0.60]、日本骨科协会评分[SMD=0.15,95%CI(-0.23,0.52),P=0.44]、日本骨科协会评分恢复率[MD=0.02,95%CI(-0.02,0.06),P=0.33]、Nurick分级[SMD=-0.34,95%CI(-0.73,0.05),P=0.09]、手术时间[SMD=-0.21,95%CI(-0.43,0.02),P=0.07]、出血量[SMD=0.28,95%CI(-0.20,0.77),P=0.25]、颈椎曲度[MD=0,95%CI(-0.49,0.77),P=1.00]、活动度[SMD=0.41,95%CI(-0.48,1.31),P=0.37]等方面差异均无显著性意义;(3)在椎管容积增加率方面[MD=0.18,95%CI(0.06,0.30),P=0.003],颈椎单开门椎管成形术优于双开门手术;单颈椎双开门手术的术后并发症明显低于单开门手术[RR=1.5,95%CI(1.04,2.15),P=0.03],尤其体现在术后疼痛症状方面[RR=6.35,95%CI (1.93,20.92),P=0.002];(4)结果表明,与颈椎后路单开门椎管成形相比,双开门椎管成形可以更显著的减少并发症发生率,其他临床疗效二者相似;但单开门椎管成形在提高椎管容积增加率方面更具优势,因此仍需大量高质量的研究提供更充足的证据。
BACKGROUND: Whether treatment outcomes of single-door laminoplasty are different from double-door laminoplasty for cervical spondylotic myelopathy remains controversial. Even relevant meta-analysis obtains different conclusions.OBJECTIVE: To systematically evaluate the efficacy and safety of cervical posterior single-door laminoplasty versus double-door laminoplasty in the treatment of cervical spondylotic myelopathy. METHODS: Clinical trials of single-door laminoplasty versus double-door laminoplasty for cervical spondylotic myelopathy were retrieved. Literature screening, data extraction and literature evaluation were conducted by two researchers independently. The quality of the included randomized controlled trials was assessed with the bias risk assessment tool provided by Cochrane Collaborative Network. The quality of the retrospective studies was assessed with the Newcastle-Ottawa Scale score and meta-analysis was performed on RevMan 5.3 software. RESULTS AND CONCLUSION:(1) A total of 14 articles were included, involving 893 patients.(2) The meta-analysis results showed that there were no significant differences in the Visual Analogue Scale scores [SMD=0.24, 95%CI(-0.64, 1.11), P=0.60], Japan Orthopaedic Association scores [SMD=0.15, 95%CI(-0.23, 0.52), P=0.44], Japan Orthopaedic Association recovery rate [MD=0.02, 95%CI(-0.02, 0.06), P=0.33], Nurick grade [SMD=-0.34, 95%CI(-0.73, 0.05), P=0.09], operation time [SMD=-0.21, 95%CI(-0.43, 0.02), P=0.07], blood loss [SMD=0.28, 95%CI(-0.20, 0.77), P=0.25], cervical lordosis [MD=0, 95%CI(-0.49, 0.77), P=1.00], range of motion [SMD=0.41, 95%CI(-0.48, 1.31), P=0.37] between two methods.(3) In terms of cervical canal enlargement rate, single-door laminoplasty was superior to double-door laminoplasty [MD=0.18, 95%CI(0.06, 0.30), P=0.003]. The postoperative complications of double-door laminoplasty were significantly lower than those of single-door laminoplasty [RR=1.5, 95%CI(1.04, 2.15), P=0.03], especially in postoperative pain symptoms [RR=6.35, 95%CI(1.93, 20.92), P=0.002].(4) In summary, all clinical effects of cervical posterior double-door laminoplasty are similar to single-door laminoplasty, except for the few complications. But single-door laminoplasty can increase the spinal canal volume enlargement rate, so a large number of high-quality studies are needed to provide sufficient evidence.
BACKGROUND: Whether treatment outcomes of single-door laminoplasty are different from double-door laminoplasty for cervical spondylotic myelopathy remains controversial. Even relevant meta-analysis obtains different conclusions.OBJECTIVE: To systematically evaluate the efficacy and safety of cervical posterior single-door laminoplasty versus double-door laminoplasty in the treatment of cervical spondylotic myelopathy. METHODS: Clinical trials of single-door laminoplasty versus double-door laminoplasty for cervical spondylotic myelopathy were retrieved. Literature screening, data extraction and literature evaluation were conducted by two researchers independently. The quality of the included randomized controlled trials was assessed with the bias risk assessment tool provided by Cochrane Collaborative Network. The quality of the retrospective studies was assessed with the Newcastle-Ottawa Scale score and meta-analysis was performed on RevMan 5.3 software. RESULTS AND CONCLUSION:(1) A total of 14 articles were included, involving 893 patients.(2) The meta-analysis results showed that there were no significant differences in the Visual Analogue Scale scores [SMD=0.24, 95%CI(-0.64, 1.11), P=0.60], Japan Orthopaedic Association scores [SMD=0.15, 95%CI(-0.23, 0.52), P=0.44], Japan Orthopaedic Association recovery rate [MD=0.02, 95%CI(-0.02, 0.06), P=0.33], Nurick grade [SMD=-0.34, 95%CI(-0.73, 0.05), P=0.09], operation time [SMD=-0.21, 95%CI(-0.43, 0.02), P=0.07], blood loss [SMD=0.28, 95%CI(-0.20, 0.77), P=0.25], cervical lordosis [MD=0, 95%CI(-0.49, 0.77), P=1.00], range of motion [SMD=0.41, 95%CI(-0.48, 1.31), P=0.37] between two methods.(3) In terms of cervical canal enlargement rate, single-door laminoplasty was superior to double-door laminoplasty [MD=0.18, 95%CI(0.06, 0.30), P=0.003]. The postoperative complications of double-door laminoplasty were significantly lower than those of single-door laminoplasty [RR=1.5, 95%CI(1.04, 2.15), P=0.03], especially in postoperative pain symptoms [RR=6.35, 95%CI(1.93, 20.92), P=0.002].(4) In summary, all clinical effects of cervical posterior double-door laminoplasty are similar to single-door laminoplasty, except for the few complications. But single-door laminoplasty can increase the spinal canal volume enlargement rate, so a large number of high-quality studies are needed to provide sufficient evidence.
引文
[1]Toledano M, Bartleson JD.Cervical spondylotic myelopathy.Neurol Clin. 2013;31(1):287-305.
[2]Boogaarts HD, Bartels RH.Prevalence of cervical spondylotic myelopathy. Eur Spine J. 2015;24(Suppl 2):139-141.
[3]Cao JM, Jing TZ, Da LY, et al. Imaging factors that distinguish between patients with asymptomatic and symptomatic cervical spondylotic myelopathy with mild to moderate cervical spinal cord compression. Med Sci Monit. 2017;23:4901-4908.
[4]Luo J, Cao K, Huang S, et al. Comparison of anterior approach versus posterior approach for the treatment of multilevel cervical spondylotic myelopathy.Eur Spine J.2015;24(8):1621-1630.
[5]于雷,袁绍辉.多节段脊髓型颈椎病手术策略的研究进展[J].医学综述,2018,24(1):117-121.
[6]Nasto LA, Muquit S, Perez-Romera AB, et al. Clinical outcome and safety study of a newly developed instrumented French-door cervical laminoplasty technique. J Orthop Traumatol.2017;18(2):135-143.
[7]Hirabayashi K, Watanabe K, Wakano K, et al. Expansive open-door laminoplasty for cervical spinal stenotic myelopathy. Spine(Phila Pa 1976). 1983;8(7):693-699.
[8]Kurokawa T. Enlargement of the spinal canal by the sagittal splitting of spinous processes. Bessatsu Seikeigeka. 1982;2:234-240.
[9]Nakashima H, Kato F, Yukawa Y, et al. Comparative effectiveness of open-door laminoplasty versus French-door laminoplasty in cervical compressive myelopathy. Spine(Phila Pa 1976). 2014;39(8):642-647.
[10]Asgari S, Bassiouni H, Massoud N, et al. Decompressive laminoplasty in multisegmental cervical spondylotic myelopathy:bilateral cutting versus open-door technique.Acta neurochirurgica. 2009;151(7):739-749.
[11]Luo W, Li Y, Zhao J, et al. Open-versus French-door laminoplasty for the treatment of cervical multilevel compressive myelopathy:a meta-analysis.World Neurosurg.2018;117:129-136.
[12]Wang L, Wang Y, Yu B, et al. Open-door versus French-door laminoplasty for the treatment of cervical multilevel compressive myelopathy. J Clin Neurosci. 2015;22(3):450-455.
[13]Lee DG, Lee SH, Park SJ, et al. Comparison of surgical outcomes after cervical laminoplasty:open-door technique versus French-door technique. J Spinal Disord Tech. 2013;26(6):E198-203.
[14]Park JH, Roh SW, Rhim SC, et al. Long-term outcomes of 2cervical laminoplasty methods:midline splitting versus unilateral single door. J Spinal Disord Tech.2012;25(8):E224-229.
[15]Okada M, Minamide A, Endo T, et al.A prospective randomized study of clinical outcomes in patients with cervical compressive myelopathy treated with open-door or French-door laminoplasty. Spine(Phila Pa 1976). 2009;34(11):1119-1126.
[16]丁文元,王磊,张为,等.颈后路两种手术方式治疗脊髓型颈椎病远期疗效比较[J].颈腰痛杂志,2008,29(3):239-241.
[17]郭宇宁,王俊波,贾本让.颈后路双开门椎管扩大成型术治疗脊髓型颈椎病的疗效[J].临床医药文献电子杂志, 2017,4(80):15688-15688.
[18]王玺,李钦亮,刘艺,等.颈椎后路单、双开门椎管成形术治疗多节段脊髓型颈椎病的临床比较[J].颈腰痛杂志, 2012,33(2):88-91.
[19]王鹏瑞.微型钛板改良单开门椎管扩大成形术与应用椎板线锯改良双开门椎管扩大成形术治疗多节段脊髓压迫型颈椎病的临床疗效比较[D].大连:大连医科大学,2016.
[20]梁和胜,肖立军,邓德礼.颈椎后路单开门与双开门椎管扩大修复多节段脊髓型颈椎病:颈椎活动度对比[J].中国组织工程研究,2016, 20(22):3235-3241.
[21]王金应.颈椎后路单开门椎管扩大成形术与双开门椎管扩大成形术治疗多节段CSM的对比分析[D].福州:福建医科大学,2013.
[22]唐常辉.两种手术方法治疗脊髓型颈椎病的临床疗效分析[J].中国保健营养, 2015,25(12):93.
[23]谭江海.双开门侧块螺钉固定植骨治疗多节段脊髓型颈椎病疗效观察[J].医药前沿, 2014,4(25):163-164.
[24]Baek HC, Kang SH, Jeon SR, et al. Comparison of early surgical outcome between unilateral open-door laminoplasty and midline splitting laminoplasty. J Korean Neurosurg Soc.2007;1(6):382-386.
[25]Seng C, Tow BP, Siddiqui MA, et al. Surgically treated cervical myelopathy:a functional outcome comparison study between multilevel anterior cervical decompression fusion with instrumentation and posterior laminoplasty. Spine J. 2013;13(7):723-731.
[26]Wang MC, Kreuter W, Wolfla CE, et al.Trends and variations in cervical spine surgery in the United States:Medicare beneficiaries, 1992 to 2005.Spine(Phila Pa 1976). 2009;34(9):955-961.
[27]杨晓江,张扬,胡珊博,等.颈椎后路单开门椎管扩大成形术椎板开门值测量的新方法及新装置[J].国际骨科学杂志, 2018,39(3):191-193.
[28]呼艳立.颈椎后路双开门椎管扩大成形术对颈椎管狭窄症脊髓功能的影响[J].深圳中西医结合杂志,2018,28(17):116-118
[29]范志丹,李青,梁道臣,等.颈椎后路单、双开门椎管扩大成形术在颈椎管狭窄症中的效果对比[J].中国当代医药, 2017,24(16):98-100.
[2]Boogaarts HD, Bartels RH.Prevalence of cervical spondylotic myelopathy. Eur Spine J. 2015;24(Suppl 2):139-141.
[3]Cao JM, Jing TZ, Da LY, et al. Imaging factors that distinguish between patients with asymptomatic and symptomatic cervical spondylotic myelopathy with mild to moderate cervical spinal cord compression. Med Sci Monit. 2017;23:4901-4908.
[4]Luo J, Cao K, Huang S, et al. Comparison of anterior approach versus posterior approach for the treatment of multilevel cervical spondylotic myelopathy.Eur Spine J.2015;24(8):1621-1630.
[5]于雷,袁绍辉.多节段脊髓型颈椎病手术策略的研究进展[J].医学综述,2018,24(1):117-121.
[6]Nasto LA, Muquit S, Perez-Romera AB, et al. Clinical outcome and safety study of a newly developed instrumented French-door cervical laminoplasty technique. J Orthop Traumatol.2017;18(2):135-143.
[7]Hirabayashi K, Watanabe K, Wakano K, et al. Expansive open-door laminoplasty for cervical spinal stenotic myelopathy. Spine(Phila Pa 1976). 1983;8(7):693-699.
[8]Kurokawa T. Enlargement of the spinal canal by the sagittal splitting of spinous processes. Bessatsu Seikeigeka. 1982;2:234-240.
[9]Nakashima H, Kato F, Yukawa Y, et al. Comparative effectiveness of open-door laminoplasty versus French-door laminoplasty in cervical compressive myelopathy. Spine(Phila Pa 1976). 2014;39(8):642-647.
[10]Asgari S, Bassiouni H, Massoud N, et al. Decompressive laminoplasty in multisegmental cervical spondylotic myelopathy:bilateral cutting versus open-door technique.Acta neurochirurgica. 2009;151(7):739-749.
[11]Luo W, Li Y, Zhao J, et al. Open-versus French-door laminoplasty for the treatment of cervical multilevel compressive myelopathy:a meta-analysis.World Neurosurg.2018;117:129-136.
[12]Wang L, Wang Y, Yu B, et al. Open-door versus French-door laminoplasty for the treatment of cervical multilevel compressive myelopathy. J Clin Neurosci. 2015;22(3):450-455.
[13]Lee DG, Lee SH, Park SJ, et al. Comparison of surgical outcomes after cervical laminoplasty:open-door technique versus French-door technique. J Spinal Disord Tech. 2013;26(6):E198-203.
[14]Park JH, Roh SW, Rhim SC, et al. Long-term outcomes of 2cervical laminoplasty methods:midline splitting versus unilateral single door. J Spinal Disord Tech.2012;25(8):E224-229.
[15]Okada M, Minamide A, Endo T, et al.A prospective randomized study of clinical outcomes in patients with cervical compressive myelopathy treated with open-door or French-door laminoplasty. Spine(Phila Pa 1976). 2009;34(11):1119-1126.
[16]丁文元,王磊,张为,等.颈后路两种手术方式治疗脊髓型颈椎病远期疗效比较[J].颈腰痛杂志,2008,29(3):239-241.
[17]郭宇宁,王俊波,贾本让.颈后路双开门椎管扩大成型术治疗脊髓型颈椎病的疗效[J].临床医药文献电子杂志, 2017,4(80):15688-15688.
[18]王玺,李钦亮,刘艺,等.颈椎后路单、双开门椎管成形术治疗多节段脊髓型颈椎病的临床比较[J].颈腰痛杂志, 2012,33(2):88-91.
[19]王鹏瑞.微型钛板改良单开门椎管扩大成形术与应用椎板线锯改良双开门椎管扩大成形术治疗多节段脊髓压迫型颈椎病的临床疗效比较[D].大连:大连医科大学,2016.
[20]梁和胜,肖立军,邓德礼.颈椎后路单开门与双开门椎管扩大修复多节段脊髓型颈椎病:颈椎活动度对比[J].中国组织工程研究,2016, 20(22):3235-3241.
[21]王金应.颈椎后路单开门椎管扩大成形术与双开门椎管扩大成形术治疗多节段CSM的对比分析[D].福州:福建医科大学,2013.
[22]唐常辉.两种手术方法治疗脊髓型颈椎病的临床疗效分析[J].中国保健营养, 2015,25(12):93.
[23]谭江海.双开门侧块螺钉固定植骨治疗多节段脊髓型颈椎病疗效观察[J].医药前沿, 2014,4(25):163-164.
[24]Baek HC, Kang SH, Jeon SR, et al. Comparison of early surgical outcome between unilateral open-door laminoplasty and midline splitting laminoplasty. J Korean Neurosurg Soc.2007;1(6):382-386.
[25]Seng C, Tow BP, Siddiqui MA, et al. Surgically treated cervical myelopathy:a functional outcome comparison study between multilevel anterior cervical decompression fusion with instrumentation and posterior laminoplasty. Spine J. 2013;13(7):723-731.
[26]Wang MC, Kreuter W, Wolfla CE, et al.Trends and variations in cervical spine surgery in the United States:Medicare beneficiaries, 1992 to 2005.Spine(Phila Pa 1976). 2009;34(9):955-961.
[27]杨晓江,张扬,胡珊博,等.颈椎后路单开门椎管扩大成形术椎板开门值测量的新方法及新装置[J].国际骨科学杂志, 2018,39(3):191-193.
[28]呼艳立.颈椎后路双开门椎管扩大成形术对颈椎管狭窄症脊髓功能的影响[J].深圳中西医结合杂志,2018,28(17):116-118
[29]范志丹,李青,梁道臣,等.颈椎后路单、双开门椎管扩大成形术在颈椎管狭窄症中的效果对比[J].中国当代医药, 2017,24(16):98-100.