Bryan颈椎间盘置换与颈前路间盘切除植骨融合疗效的系统分析

A meta-analysis of clinical effects of Bryan cervical disc replacement versus anterior cervical discectomy and fusion

背景:Bryan颈椎间盘置换与颈前路间盘切除植骨融合治疗颈椎病的临床疗效存在争议。目的:应用Meta分析方法,评价Bryan颈椎间盘置换与颈前路间盘切除植骨融合治疗颈椎病的临床疗效,为临床选择颈椎病的治疗方案提供依据。方法:计算机检索Medline、PubMed、EMBASE、OVID、中国生物医学数据库、万方数据库和中国知网数据库,手工检索中国主要7种骨科杂志,检索Bryan颈椎间盘置换与颈前路间盘切除植骨融合治疗颈椎病的临床研究。按照文中的纳入标准进行研究。提取颈椎总活动度、疼痛目测类比评分、颈部功能障碍指数、日本矫形外科协会评分等相关数据,利用RevMan4.2.2软件进行异质性和Meta分析,绘制森林图。结果与结论:8篇文献符合纳入标准,共883例患者,其中Bryan颈椎间盘置换430例,颈前路间盘切除植骨融合453例。Meta分析发现在治疗后3个月和24个月,Bryan颈椎间盘置换组颈椎总活动度高于颈前路间盘切除植骨融合组;治疗后12个月2组差异无显著性意义。治疗后12个月和24个月2组疼痛目测类比评分、颈部功能障碍指数的差异无显著性意义。治疗后24个月2组日本矫形外科协会评分的差异无显著性意义。结果说明在治疗颈椎病时,在治疗后颈椎总活动度方面,Bryan颈椎间盘置换优于颈前路间盘切除植骨融合,但2种治疗方案的神经减压效果无明显差异。

BACKGROUND： Bryan cervical disc replacement and anterior cervical discectomy and fusion have a dispute in the treatment of cervical spondylosis. OBJECTIVE： To evaluate the clinical effects of Bryan cervical disc replacement and anterior cervical discectomy and fusion by meta-analysis, thereby providing clinical evidence for treatment strategy of cervical spondylosis. METHODS： The authors searched Medline, PubMed, EMBASE, OVID, CBM, CNKI and also searched manually seven relevant Chinese orthopedic journals for articles pertinent to clinical research of Bryan cervical disc replacement and anterior cervical discectomy and fusion. Extracted data included the range of motion of the cervical spine, visual analog scale score, neck disability index, the Japanese Orthopaedic Association score. Meta-analysis and forest plots were conducted with RevMan4.2.2 Software. RESULTS AND CONCLUSION： There are eight articles in the meta-analysis, including 883 patients（430 patients receiving Bryan cervical disc replacement, and 453 patients receiving anterior cervical discectomy and fusion）. Meta-analysis did detect statistically significant differences in the range of motion of the cervical spine at 3 months and 24 months postoperatively between the two groups, but did not detect statistically significant differences in visual analog scale score, neck disability index, the Japanese Orthopaedic Association score between the two groups. These findings indicate that Bryan cervical disc replacement is superior to anterior cervical discectomy and fusion in the range of motion of the cervical spine. However, the current literature offers no evidence to support superiority of the Bryan cervical disc replacement over the anterior cervical discectomy and fusion.