颈椎前路与后路手术治疗多节段脊髓型颈椎病疗效的Meta分析

Anterior versus posterior approach for multilevel cervical spondylotic myelopathy:a meta-analysis

目的:系统评价颈椎前路与后路手术治疗多节段脊髓型颈椎病的疗效与安全性。方法:计算机检索Cochrane图书馆(2015年第7期),Pub Med(1966年至2015年12月),EMbase(1966年至2015年12月),OVID(1950年至2015年12月),万方数据库(1998年至2015年12月),中国期刊全文数据库(1999年至2015年12月),中国生物医学文献数据库(1978年至2015年12月),手工检索《中华骨科杂志》《中国脊柱脊髓杂志》等相关杂志,收集颈椎前路与后路手术治疗多节段脊髓型颈椎病的随机或半随机对照试验,由2名评价者按纳入与排除标准筛选试验、质量评价和提取资料后,采用RevMan 5.2软件进行Meta分析。结果:最终纳入17个对照试验,共1 151例患者。Meta分析结果显示:前路手术与后路手术的术后并发症发生率[OR=2.19,95%CI(1.50,3.19),P<0.000 1]和神经功能改善率[WMD=11.04,95%CI(0.60,21.47),P=0.04]的差异有统计学意义;而手术时间[WMD=39.43,95%CI(-5.92,84.78),P=0.09],术中出血量[WMD=5.46,95%CI(-96.65,107.58),P=0.92],术前JOA评分[WMD=0.13,95%CI(-0.20,0.46),P=0.44],术后JOA评分[WMD=0.45,95%CI(-0.10,1.00),P=0.11]的差异无统计学意义。结论:颈椎前路手术与后路手术治疗多节段脊髓型颈椎病在脊髓神经功能改善、手术时间、术中出血量方面无显著差异,但后路手术在减少并发症方面明显优于前路手术。

Objective ：To assess the clinical effectiveness and safety of anterior versus posterior approach for multilevel cervical spondylotic myelopathy. Methods：The following databases were searched：the Cochrane Library, PubMed,EM base, OVID, CBM, Wanfang Data, CNKI. Relevant journals were manually searched for randomized controlled trials or clinical con- trolled trials （CCTs） that investigated the clinical effectiveness and safety of anterior and posterior approach for multilevel cer- vical spondylotic myelopathy. Two reviewers independently screened the literature according to inclusion and exclusion criteria,extracted the data, and assessed the methodological quality of included studies. Meta-analysis was performed by using RevMan 5.2 software. Results：Eight CCTs, involving 1 151 patients, were included. Significant differences were found between anterior and posterior approach with respect to complications, 0R=2.19,95%CI （1.50,3.19）,P〈0. 000 1 ; and neural recovery rate,WMD =11.04,95% CI （0.60,21.47）,P=0.04 . In addition,there were no significant differences in preoperative JOA scores, WMD=0.13,95% CI （-0.20,0.46）,P=0. 44; postoperative JOA scores,WMD=0.45,95% CI （-0.10,1.00） ,P= 0.11 ; operation time, WMD=39.43,95% CI （-5.92,84.78）, P=0.09 ; and amount of intraoperative bleeding, WMD=5.46,95% CI （-96.65,107.58）, P=0. 92）. Conclusion：There are no significant differences between anterior and posterior approach for multilevel cervical spondylotic myelopathy in the recovery of neural function of the spinal cord, operation time and intraoperatire bleeding. However, posterior appreach showed fewer complications than anterior appreach.