颈椎人工间盘置换与前路融合对相邻节段在体运动影响的Meta分析

Influence of cervical disc replacement versus anterior cervical discectomy and fusion on the in-vivo kinematics of the adjacent segments: a meta-analysis

[目的]比较颈椎间盘置换和前路融合两种不同手术方式对相邻节段在体运动影响。[方法]计算机检索Cochrane library、Pubmed、Ovid、ELSEVIER Science Direct、Springerlink、中国期刊全文数据库、万方数据库、中国生物医学文献数据库（时间截至2014年10月）,手工检索相关杂志,纳入有关人工颈椎间盘置换和前路融合术后相邻节段在体运动学研究的文献,利用Rev Man5.3（下载于Cochrane Library）进行Meta分析,选取手术部位相邻上下节段矢状面运动范围、C2~7整体矢状面运动范围等指标进行比较分析。[结果]经过筛选,16篇文献符合纳入标准,共1 666例。Meta分析结果显示：前路融合术后手术部位上方相邻节段矢状面运动范围增大：随机对照组[MD=-1.34,95%CI（-2.39,-0.30）,P=0.01],非随机对照组[MD=-1.38,95%CI（-1.61,-1.14）,P〈0.00001];下方相邻节段矢状面运动范围也增大：随机对照组[MD=-1.23,95%CI（-1.63,-0.82）,P〈0.000 01],非随机对照组[MD=-1.85,95%CI（-2.82,-0.89）,P=0.000 2];颈椎整体矢状面运动范围随机对照组示两种术式无差异[MD=1.70,95%CI（-3.29,6.69）,P=0.50],而非随机对照组示间盘置换术后颈椎整体运动范围比前路融合组大[MD=8.31,95%CI（3.63,13.00）,P=0.000 5]。[结论]颈椎前路融合术后相邻节段的活动范围比椎间盘置换增大,从一个侧面可能解释颈椎融合后相邻节段疾病发生率比人工颈椎间盘置换高的临床现象。

[Objective] To compare the effects on adjacent segments after cervical disc replacement or anterior cervical discectomy and fusion. [Methods] A computer-based online search of Pubmed,Ovid,ELSEVIER Science Direct,Springerlink,China National Knowledge Internet,China Biological Medicine Database,Wan Fang DATA,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. Rev Man 5. 3 was used for data analysis. The following indexes were used to compare the results： the range of motion of the upper and lower adjacent segments,the range of motion of the C2 ~ 7. [Results] Sixteen studies involving 1666 patients were included. The results of Meta-analysis indicated that statistically significant differences had been noted between two procedures for the range of motion of the upper adjacent segments in both randomized controlled group（ MD =-1. 34,95% CI（-2. 39,-0. 30）,P = 0. 01） and non-randomized controlled group（ MD =-1. 38,95% CI（-1. 61,-1. 14）,P〈0. 000 01）,the range of motion of the lower adjacent segments in both randomized controlled group（ MD =-1. 23,95% CI（-1. 63,-0. 82）,P〈0. 000 01） and non-randomized controlled group（ MD =-1. 85,95%CI（-2. 82,-0. 89）,P = 0. 000 2）. No statistically significant differences was noted between two procedures for the range of motion of the C2-C7 in randomized controlled group（ MD = 1. 70,95% CI（-3. 29,6. 69）,P = 0. 50）,however,statistically significant differences was noted between two procedures for the range of motion of the C2 ~ 7in non-randomized controlled group（ MD = 8. 31,95% CI（ 3. 63,13. 00）,P = 0. 000 5）. [Conclusion] The range of motion on adjacent segments after anterior cervical discectomy and fusion is larger compared with that after cervical disc replacement,this may explain the higher incidence of adjacent segment disease after anterior cervical discectomy compared with that after cervical disc replacement.