颈椎间盘置换术与颈椎融合术治疗双节段颈椎病疗效比较的Meta分析

Total cervical disc replacement and anterior discectomy and fusion for double segment cervical disc disease:a Meta-analysis

目的系统评价颈椎间盘置换术(total disc replacement,TDR)与颈椎融合术治疗双节段颈椎病的疗效与安全性。方法对2004年1月至2014年1月中文科技期刊数据库(VIP)、万方数据库、中国知网、PubMed Central(PMC)、MEDLINE、OVID、Google Scholar数据库中的相关文献进行电子检索及手工检索,纳入TDR(置换组)与颈椎融合术(融合组)治疗双节段颈椎病的随机对照试验(randomized controlled trial,RCT),根据Jadad评分标准评价纳入研究项目的质量。采用Rev Man5.2统计学软件进行Meta分析。结果 8项研究符合纳入标准,共计1 100例患者。Meta分析结果显示,置换组术后2年的患者满意率、颈椎活动度(ROM)、日本骨科协会(Japanese Orthopaedic Association,JOA)评估治疗分数及疼痛视觉模拟评分(visual analogue scale,VAS)均优于融合组,置换组术后2年的再手术率及并发症低于融合组,其余各项指标差异均无统计学意义。结论 TDR治疗双节段颈椎病的疗效与安全性较颈椎融合术有优势,但仍需更多的大样本RCTs进行验证。

Objective To assess the therapeutic effectiveness and safety of total cervical disc replacement （TDR） and fusion for double segment cervical disc disease. Methods Literatures were searched from VIP, Wan Fang, PubMed Central （PMC）, MEDLINE, OVID, and Google Scholar （2004. （/1-2（114. 01）, and enrolled into the randomized controlled trails （RCTs） of TDR （TDR group） and fusion （fusion group） for double segment cervical disc disease. The quality of RCTs was evaluated according to Jadad score standard, and Rev Man5.2 was used for Meta-analysis. Results Eight studies involving 1 100 patients were included. The meta-analysis results indicated that the satisfaction rate, ROM, JOA scores and VAS scores at 2nd year after operation were significantly higher in TDR group than in fusion group. The 2-year re-operation rate and incidence of complications in TDR group were significantly lower than in fusion group. Conclusion The therapeutic effectiveness of TDR is superior to fusion, which is further verified by large-size RCTs.