颈椎间盘置换术与前路减压椎间融合术术后疼痛及残障指数比较的Meta分析

Comparison of postoperative pain and neck function between cervical disc replacement and anterior cervical discectomy and fusion： a Meta-analysis

目的收集并分析有关颈椎间盘置换术与颈前路减压椎间融合术（anterior cervical discectomy and fusion，ACDF）术后疗效比较的文献，对颈椎间盘置换术和ACDF术后疼痛及残障指数进行Meta分析。方法检索Medline（1966年1月至2008年11月）、Embase（1966年1月至2008年11月）、AMED（1985年1月至2008年11月）和Cochrane Library等数据库中关于颈椎间盘置换术和ACDF术后疗效比较的随机对照研究，纳入符合标准的文献，提取相关数据输入Review Manager4．2软件进行统计学分析。臂部疼痛及颈部疼痛的视觉模拟评分（visual analogue scale，VAS）、颈部功能残障指数（neck disability index，NDI）均采用权重均差（weighted mean difierence，WMD）进行评价。结果共4篇文献符合纳入标准，经改良Jadad评分判定均为高质量研究。共纳入213例，干预组（颈椎间盘置换组）和对照组（ACDF组）术后6周臂部疼痛VAS合并WMD为-2．91[95％置信区间（-4．19，-1．62），P〈0．05]，术后6个月合并WMD值为-2．67[95％置信区间（-4．02，-1．33），P〈0．05]。干预组和对照组术后6周NDI合并WMD值为-11．93[95％置信区间（-15．66，-8．19），P〈0．05]，术后6个月合并WMD值为-11．2[95％置信区间（-14．74，-7．69），P〈0．05]。结论颈椎间盘置换术后6周和6个月时患者臂部疼痛程度低于ACDF；颈椎间盘置换术后6周和6个月患者颈部功能恢复程度高于ACDF。

Objective To evaluate the postoperative pain and neck function of patients who underwent cervical disc replacement or anterior cervical diseectomy and fusion （ACDF） by Meta-analysis. Methods In Medline （1966.1-2008.11）, Embase （1966.1-2008.11）, AMED （1985.1-2008.11） and Cochrane Library, the randomized controlled trails about the comparison between cervical disc replacement and ACDF were collected. Then extracted the data of arm pain visual analogue scale （VAS）, neck pain VAS and neck disability index （NDI） in these researches and made a Meta-analysis using Review Manager 4.2. Weighted mean difference （WMD） was selected for the evaluation of the overall effect. Results Four articles were accepted in our Meta-analysis and all of them were high quality researches identified by modified Jadad Scale. Altogether, 213 patients were included. The combined WMD of arm pain VAS was -2.91195% confidence interval （CI） （-4.19-1.62）, P〈 0.05] 6 weeks after surgery and -2.67 [95%CI （-4.02,-1.33）, P〈0.05] 6 months after surgery. The combined WMD of NDI was -1 1.93 [95%CI （-15.66,-8.19）, P〈 0.05] 6 weeks after surgery and -11.2 [95%Cl （-14.74,-7.69）, P〈 0.05] 6 months after surgery. Conclusion The arm pain VAS of treatment group （cervical disc replacement） is lower than that of control group （ACDF） both 6 weeks and 6 months after surgery. The NDI of treatment group is lower than that of control group both 6 weeks and 6 months after surgery.