颈椎前路减压椎间融合器或自体骨植骨融合治疗颈椎病的Meta分析

Anterior cervical decompression and fusion (ACDF) with cage placement or autograft for cervical myelopathy,a meta-analysis

目的:系统评价颈椎前路减压椎间融合器(cage)或自体骨植骨融合治疗颈椎病的疗效。方法:计算机检索MEDLINE、EMBASE、Cochrane CENTRAL(First Quarter 2011)、ScienceDirect、OVID、SpringerLink、中国生物医学文献数据库7个数据库(时间截至2011年6月),手工检索Spine、Euro Spine、JBJS、中华骨科、中国脊柱脊髓等相关杂志,纳入关于颈椎前路减压椎间融合器或自体骨植骨融合治疗颈椎病的RCT研究,评价纳入研究的方法学质量。利用RevMan5.1.1(下载于Cochrane Library)进行Meta分析。选取平均手术时间、失血量、住院时间、并发症发生率、融合率、优良率、取骨处疼痛等指标进行比较。结果:经过筛选,11篇研究符合纳入标准,共1139个病例。纳入研究的质量评价等级均较高(A级10个,B级1个)。Meta分析结果显示:颈椎椎间融合器(cage)融合组与自体骨植骨融合组比较,前者平均术中失血量少于后者[MD=-8.42,95%CI(-15.59,-1.25),P=0.02],平均住院时间短于后者[MD=-0.31,95%CI(-0.62,-0.01),P=0.05],术后并发症发生率小于后者[OR=0.56,95%CI(0.37,0.83),P=0.004],取骨处疼痛二者间存在统计学差异[OR=0.06,95%CI(0.01,0.27),P=0.0002];平均手术时间[MD=-14.55,95%CI(-30.79,1.69),P=0.08]、融合率[OR=1.44,95%CI(0.70,2.96),P=0.32]、优良率[OR=1.39,95%CI(0.92,2.09),P=0.12],两种融合方式之间差异无统计学意义。结论:颈椎椎间融合器(Cage)与自体骨植骨融合治疗颈椎病都取得了良好的疗效。应用cage行椎间融合可以减少术中出血量,缩短住院时间,减少并发症尤其是取骨处疼痛的发生,并且在平均手术时间、融合率、优良率等方面与自体骨植骨融合效果相同。

Objective：To investigate the efficacy of anterior cervical decompression and fusion（ACDF） with cage placement or autograft for cervical myelopathy.Method：A computer-based online search of Medline,EMBASE,Cochrane CENTRAL（1st Quarter 2011）,ScienceDirect,OVID,SpringerLink and China Biological Medicine Database,and hand search of several related journals were performed.The included trials were screened out according to the criterion of inclusion and exclusion.The quality of included trials was evaluated.Data were extracted by two reviewers independently.RevMan 5.1.1 was used for data analysis.The following indexes were used to compare the results：mean operation time,blood loss,inpatient stay,complication rate,fusion rate,excellent to good rate and donor site pain.Result：11 studies involving 1139 patients were included.The levels of included studies were very high.The results of Meta-analysis indicated that statistically significant differences were noted between two procedures for the blood loss[MD=-8.42,95%CI（-15.59,-1.25）,P=0.02],inpatient stay[MD=-0.31,95%CI（-0.62,-0.01）,P=0.05],complication rate[OR=0.56,95%CI（0.37,0.83）,P=0.004] and donor site pain[OR=0.06,95%CI（0.01,0.27）,P=0.0002].While no difference were noted for the mean operation time[MD=-14.55,95%CI（-30.79,1.69）,P=0.08],fusion rate[OR=1.44,95%CI（0.70,2.96）,P=0.32] and excellent and good rate[OR=1.39,95%CI（0.92,2.09）,P=0.12].Conclusion：Both cage and autograft fusion are effective for cervical myelopathy.Compared with autograft,cage can decrease blood loss,shorten inpatient time and decrease the rate of complications,especially the donor site pain.As for the mean operation time,fusion rate and excellent to good rate,2 procedures are equal.