颈椎间盘置换与颈前路减压植骨融合治疗单节段颈椎病:中长期随访结果Meta分析

Mid-and long-term outcomes of cervical disc arthroplasty versus anterior cervical discectomy and fusion for single-level cervical spondylosis: a meta-analysis

背景:颈前路减压植骨融合被认为是治疗退变性颈椎病"金标准",但随着颈椎间盘置换在临床广泛应用,有取而代之的趋势,但中长期疗效二者孰优孰劣,一直存在争议。目的:比较颈前路减压植骨融合和颈椎间盘置换治疗单节段颈椎病的中长期疗效。方法:检索PubM ed、Medline、Embase、Cochrane、CBM、CNKI、VIP和万方数据库,时间为建库至2016年8月,搜索关于颈椎间盘置换与颈前路减压植骨融合比较治疗单节段颈椎病的随机对照试验,进行严格的质量评价,提取相关数据,并通过ReviewM anager5.3软件进行Meta分析。结果与结论:(1)共纳入15篇文献,2 781例患者,随访时间4-10年;(2)Meta分析结果提示,颈椎间盘置换与颈前路减压植骨融合相比,术后中长期随访SF-36评分较优、手术节段活动度较大、颈椎功能障碍指数评分较低、臂痛目测类比评分较低、手术节段再手术率较低、邻近节段再手术率较低(P<0.05);(3)两组在颈痛目测类比评分、神经功能改善率和总并发症率方面差异无显著性意义;(4)结果说明,颈椎间盘置换治疗单节段颈椎病的中长期疗效优于颈前路减压植骨融合,但该结论还需更多大样本、多中心、高质量的随机对照试验来进一步论证。

BACKGROUND： Anterior cervical discectomy and fusion （ACDF） is the gold standard for degenerative cervical disease,which would be replaced by cervical disc arthroplasty （CDA） with the wide application of CDA. But, the mid- and long-term outcomes of ACDF versus CDA remain controversial.OBJECTIVE： To compare the mid- and long-term outcomes of ACDF and CDA in the treatment of single-level cervical spondylosis.METHODS： PubMed, Medline, EMbase, Cochrane, CBM, CNKI, VIP and WanFang databases were searched for randomized controlled trials addressing CDA versus ACDF for single-level cervical spondylosis published before August 2016. The quality of trails was strictly evaluated, the data were extracted and a meta-analysis was performed on ReviewManager5.3 software.RESULTS AND CONCLUSION： （1） Totally 15 randomized controlled trials involving 2781 patients were included, with 4-10 years of follow-up. （2） Meta-analysis results showed that compared with ACDF, CDA had better SF-36 scores,larger range of motion at operation level, lower the Neck Disability Index, and Visual Analogue Scale scores for arm pain,lower reoperation rate at operation level and adjacent level at mid- and long-term follow-up. （3） The Visual Analogue Scale scores for neck pain, neurologic success and all-complication rate did not differ significantly between two groups.（4） These results manifest that CDA is superior to ACDF in the mid- and long-term outcomes for single-level cervical spondylosis; however, further large-scale, multi-center and high-quality randomized controlled trials will be necessary.