前入路与后入路手术治疗颈椎后纵韧带骨化症疗效和安全性的Meta分析

Efficacy and safety of anterior and posterior approach for the surgical treatment in ossification of the posterior longitudinal ligament:a meta-analysis

目的系统评价前入路手术和后入路手术比较治疗颈椎后纵韧带骨化症(OPLL)的疗效和安全性。方法计算机检索PubMed、EMbase、The Cochrane Library、Web of Science、WanFang Data和CNKI数据库,搜集前入路手术和后入路手术比较治疗颈椎OPLL的临床研究,检索时限均从建库至2016年12月。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Rev Man 5.3软件进行Meta分析。结果共纳入20个研究,1 263例患者。Meta分析结果显示:前入路手术组的术后JOA评分[MD=0.98,95%CI(0.52,1.44),P<0.000 1]和改善[MD=12.18,95%CI(6.65,17.71),P<0.000 1]更高,但其再手术率更高[OR=3.21,95%CI(1.70,6.08),P=0.000 3],手术时间更长[MD=53.43,95%CI(12.77,94.09),P=0.01],术中出血量更多[MD=122.88,95%CI(39.56,206.20),P=0.004]。两组在并发症发生率方面差异无统计学意义[OR=1.49,95%CI(0.88,2.51),P=0.14]。结论前入路手术治疗颈椎OPLL可获得更好的术后神经功能改善和较低的神经功能恶化,但后入路手术的再手术率、术中出血量、手术用时均低于前入路手术。两组并发症发生率相当。受纳入研究的样本量和质量限制,上述结论尚需开展更多高质量研究予以验证。

Objective To systematically review the efficacy and safety of the anterior and posterior approach for the treatment in ossification of the posterior longitudinal ligament （OPLL） of the cervical spine. Methods An electronical search was conducted in PubMed, EMbase, The Cochrane Library, Web of Science, WanFang Data and CNKI from inception to December 2016 to collect studies which compared the anterior cervical approach with posterior approach for OPLL. Two reviewers independently screened literature, extracted data and assessed the risk bias of included studies and then RevMan 5.3 software was used to perform meta-analysis. Results A total of 20 studies involving 1 263 patients were included. The results of meta-analysis showed that： compared with the posterior approach group, the anterior approach group had higher postoperative JOA score （MD=0.98, 95%CI 0.52 to 1.44, P〈0.000 1）, higher improvement （MD=12.18, 95% CI 6.65 to 17.71, P〈0.000 1）, higher re-operation rate （OR=3.21, 95%CI 1.70 to 6.08, P=0.000 3）, longer operation time （MD=53.43, 95%CI 12.77 to 94.09, P=0.01） and more bleeding （MD=122.88, 95%CI 39.56 to 206.20, P--0.004）, respectively. There was no significant difference in the incidence of complications between two groups （OR=1.49, 95%CI 0.88 to 2.51, P=0.14）. Conclusion The anterior approach for the treatment in OPLL of the cervical spine can achieve better postoperative neurological improvement and lower neurological deterioration, while the posterior approach for the treatment in OPLL has lower re-operation rate, less blood loss and shorter operation time. The incidence of complications between two groups is similar. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.