中国大陆退行性颈椎病患者人工颈椎间盘置换术后再手术发生率的Meta分析

Reoperation after cervical disc replacement in Chinese mainland population with degenerative cervical disease: A Meta-analysis

目的了解中国大陆地区退行性颈椎病患者接受人工颈椎间盘置换(ACDR)术后再手术的发生率。方法 2016年10月利用"人工颈椎间盘置换"和"cervical disc replacement"等检索词系统检索中国生物医学文献数据库、CHKD期刊全文数据库、维普中文科技期刊数据库、万方医学期刊数据库、Pubmed数据库、OVID平台数据库、Cochrane Library数据库和Embase数据库。对于符合纳入与排除标准的文献,提取基本信息、方法学特征、干预特征和再手术发生情况等信息,采用Stata 12.0对纳入文献中不同随访时间的再手术发生率进行合并分析。结果纳入文献31篇,其中随机对照试验8篇,类试验6篇,病例系列17篇,包括1 105例研究对象。报告随访12、24、36、48、60和72个月再手术发生情况的文献分别有10、13、4、4、3、3篇。合并分析结果显示,ACDR术后12、24、36、48、60和72个月再手术发生率分别为1.3%(95%CI:0.1%~2.5%),1.2%(95%CI:0.3%~2.2%),1.0%(95%CI:-0.5%~2.6%),1.5%(95%CI:-0.3%~3.3%),1.7%(95%CI:-0.3%~4.1%),4.8%(95%CI:0.5%~9.2%)。结论中国大陆人群退行性颈椎病患者接受ACDR后再手术的发生率较低,再手术主要发生在ACDR术后1年内,随后至术后第6年再手术的发生率有轻度升高。

Objective To investigate the occurrence of reoperation after artificial cervical disc replace- ment （ACDR） in Chinese mainland population with degenerative cervical disease. Methods A series of data-bases including Chinese Biomedical Literature Database （CBM）, Chinese Academic Journals Full-Text Data- base （CNKI） , Chinese Science and Technology Journal Database （VIP）, Wanfang Database, PubMed, OVID, Cochrane Library and Embase were searched using ＂cervical disc replacement＂ as key words in October 2016. The literatures were strictly selected according to inclusion and exclusion criteria. The basic and reopera- tion related information from literatures that met the criteria were extracted and entered by two independent re- searchers. The reoperation rate of each study was then merged using the fixed or random effect model of rate Meta-analysis. Results A total of 31 literatures were included in the study, including 8 randomized contrelled trials, 6 quasi-trials and 17 case-series studies. The reoperation rates of 12, 24, 36, 48, 60 and 72 months were 1.3% （95%CI： 0.1%-2.5%）, 1.2% （95%CI： 0.3%-2.2%）, 1.0%（95%CI： -0.5%-2.6%）, 1.5%（95%CI： -0.3%-3.3%）, 1.7%（95%CI： -0.3%-4.1%） and4.8 %（95%CI： 0.5%-9.2%）, respectively. Conclusion The reoperation rate after ACDR of patients with degenerative cervical disease from