一期后路胸脊髓环形减压术治疗胸椎后纵韧带骨化症的临床疗效及并发症：系统评价及meta分析

Clinical outcomes and complications of one-stage posterior thoracic circumferential decompression for thoracic myelopathy caused by ossification of the posterior longitudinal ligament:systematic review and meta-analysis

背景:胸椎后纵韧带骨化症(T-OPLL)是导致胸脊髓病的常见原因,其治疗方式包括后路椎板切除、前路骨化块切除或前后路联合手术,近年来有作者通过一期后路胸脊髓环形减压术治疗T-OPLL。报道一期后路胸脊髓环形减压术治疗T-OPLL的文献较少,且多为临床病例系列研究。目的:探索应用一期后路胸脊髓环形减压术治疗由T-OPLL引起的胸脊髓病的临床疗效和并发症。方法:通过文献检索共纳入7项符合纳入标准的临床研究,并提取研究特征和基线数据进行系统评价和meta分析。主要结局包括术前和术后的日本骨科协会(JOA)评分(11分法)和围手术期并发症,包括脑脊液漏、脊髓功能损害、切口感染和其他并发症。使用随机效应模型计算胸椎JOA评分和并发症的总体估计值。结果:本研究共纳入156例患者,术前和术后JOA评分分别为4.0分(95%CI 2.9~5.0分,I^2=0)和8.6分(95%CI 7.3~9.9分,I^2=0),平均JOA评分改善+4.3分(95%CI 3.5~5.1分,I^2=70.6%)。早期脊髓功能损害、硬膜损伤和脑脊液漏和手术部位感染发生率合并估计值分别为17.3%(95%CI 8.9%~27.4%,I^2=53%)、29.8%(95%CI 16.1%~45.6%,I^2=74.4%)和5.7%(95%CI 1.4%~11.8%,I^2=0)。结论:继发于T-OPLL的胸脊髓病可以采用一期后路胸脊髓环形减压术治疗。但尽管JOA评分有所改善,但术后脊髓功能仍然相对较差。此外围手术期并发症很常见,硬膜损伤和脑脊液漏最常发生,术后早期脊髓功能损害发生率也较高。未来需要更多的研究来探索如何能够改善T-OPLL引起的胸脊髓病的疗效。

Background: Thoracic ossification of the posterior longitudinal ligament(T-OPLL) is a common cause of thoracic myelopathy. The treatment of T-OPLL contains posterior laminectomy, anterior ossification resection, and anterior-posterior combined surgery. In recent years, there is little literature on one-stage posterior circumferential decompression of the thoracic spinal cord fot the treatment of T-OPLL, but most of them are clinical case series. Objective: To explore clinical outcomes and complications of one-stage posterior thoracic spinal cord circumferential decompression for thoracic myelopathy caused by T-OPLL. Methods: A total of 7 clinical studies meeting the inclusion criteria were collected. Study characteristics and baseline data were extracted for systematic review and meta-analysis. Primary outcomes included preoperative and postoperative Japanese Orthopedic Association(JOA) scores(11 points) and perioperative complications, such as cerebrospinal fluid leakage, postoperative spinal cord dysfunction, incision infection, and other complications. A random effect model was used to calculate the overall estimate of the thoracic spine JOA score and complications. Results: A total of 156 patients were enrolled in the study. Preoperative and postoperative JOA scores were 4.0(95% CI: 2.9-5.0, I^2=0%) and 8.6(95% CI: 7.3-9.9, I^2=0%), respectively. JOA score was increased by 4.3 on average(95% CI: 3.5-5.1, I^2=70.6%). The combined estimates of early spinal cord dysfunction, dural tear & cerebrospinal fluid leakage, and surgical site infection were 17.3%(95% CI: 8.9%-27.4%;I^2=53%), 29.8%(95% CI: 16.1%-45.6%, I^2=74.4%) and 5.7%(95% CI: 1.4%-11.8%, I^2=0%), respectively. Conclusions: Thoracic myelopathy secondary to T-OPLL can be treated with one-stage posterior thoracic spinal cord circumferential decompression. Despite the improvement in the JOA score, postoperative spinal cord function remains relatively poor. In addition, there are many perioperative complications. Dural tear & cerebrospinal fluid leakage is the most common one. The incidence of spinal cord dysfunction is very high in the early postoperative period. It needs more researches to explore how to improve the efficacy of T-OPLL-induced thoracic myelopathy.