颈椎后纵韧带骨化症前后路手术疗效比较的meta分析

A comparative meta-analysis on the curative effects of anterior and posterior surgeries in treating the cervical OPLL

背景:目前,治疗颈椎后纵韧带骨化症(OPLL)的手术方式以前路或后路手术为主,两者疗效尚存争议。目的:通过Meta分析比较前路与后路手术治疗颈椎OPLL的临床疗效及预后,为术式选用提供理论依据。方法:检索1990年1月至2012年6月Medline、Embase及CNKI数据库发表的相关文献,对检索到的原始研究进行质量评估,对符合条件的研究结果进行meta分析,以患者的术后JOA改善率和并发症发生率为疗效观察指标,计算各个研究的OR值,通过合并OR值比较前路术式和后路术式的差异,为临床术式的合理选用提供循证依据。结果:按照日本骨科学会(JOA)神经功能评定标准,以采取前路术式为实验组,采用后路术式为对照组,疗效观察指标为两组患者的术后JOA改善率和并发症发生率。JOA改善率的合并OR值及95%CI结果为9.89[3.63,16.15],前后路比较有统计学差异;并发症发生率的合并OR值及95%CI结果为0.95[0.62,1.48],前后路比较无统计学差异。结论:前路手术较后路手术有提高术后JOA改善率的趋势,而尚无法认为前路手术较后路手术的术后并发症发生率高。证据强度均为中等强度,可推荐为临床应用证据,尚待纳入更多高质量原始研究支持结果。

Background：The main surgical method for treating the cervical ossification of the posterior longitudinal ligament（OPLL） today is the anterior or posterior surgery,but the efficacies of both the approaches are still controversial.Objective：To provide theoretical bases for selecting surgical method for treating the cervical OPLL by comparing the clinical effects and prognosis of anterior and posterior surgeries via meta-analysis.Methods：Retrieve relevant literatures published in the databases of Medline,Embase,and CNKI from January 1990 to June 2012,assess the quality of the source researches,and meta-analyze those qualified research results.Take the JOA improvement rate and the incidence of complications as the observational indexes of efficacy,and calculate the value of OR in each research.Compare the the differences between anterior and posterior approaches by pooled OR,and provide evidence basis for a reasonable selection of surgical methods.Results：According to the Japanese Orthopedic Association（JOA） assessment standards of nerve function,the anterior surgical group and the posterior surgical group were respectively taken as the experimental group and the comparison group,and the postoperative JOA improvement rate and incidence of complications of the two group of patients were taken as the observational indexes of efficacy.The pooled OR and 95% CI of the JOA improvement rate were 9.89 [3.63,16.15],there were statistical differences between the two groups;while the polled OR and 95% CI of the incidence of complications were 0.95 [0.62,1.48],there was no statistical difference.Conclusions：The anterior surgery has much more potential to increase the JOA improvement rate than the posterior surgery,however,it cannot be considered that the incidence of complications of the former is higher than that of the later.Both of their evidences are at an intermediate level and can be recommended as the evidences for clinical applications.However,it is still needed that more original researches of high quality be analyzed to support the conclusion.