超声骨刀与高速磨钻应用于颈椎后路单开门椎管扩大成形术的有效性及安全性的Meta分析

A Meta-analysis of the effectiveness and safety of ultrasonic bone curette versus high-speed drill in the treatment of cervical expansive open-door laminoplasty

目的:通过Meta分析评价应用超声骨刀(ultrasonic bone curette,UBC)与高速磨钻(high-speed drill,HSD)在颈椎后路单开门椎管扩大成形术(cervical expansive open-door laminoplasty,CEOL)中的有效性及安全性。方法:计算机检索PubMed、Embase、Web of Science、万方数据库(Wanfang Data)、中国期刊全文数据库(CNKI),搜集关于比较应用超声骨刀和高速磨钻在颈椎后路单开门椎管扩大成形术中有效性及安全性的临床对照研究,检索时限为建库至2021年3月。2名研究人员分别筛选文献、提取数据并评价纳入研究的偏倚风险后,采用Cochrane Library提供的Revman 5.3软件进行Meta分析。结果:最终纳入8个临床研究,包括4个随机对照试验(randomized controlled trial,RCT)和4个队列研究(cohort study,CS),共计631例患者,其中超声骨刀组314例,高速磨钻组317例。Meta分析结果显示,两组间术前、术后早期及末次随访时JOA评分、VAS评分、手术相关总并发症发生率、术后轴性症状和C5神经根麻痹发生率均无统计学差异(P>0.05)。然而,与高速磨钻组相比,超声骨刀组手术时间[均数差(mean difference,MD)=-24.78,95%置信区间(confidence interval,CI)为(-36.80,-12.76),P<0.0001]、术中出血量[MD=-69.94,95%CI为(-115.40,-24.47),P=0.003]、术后引流量[MD=-53.21,95%CI为(-86.95,-19.46),P=0.002]、硬脊膜撕裂发生率[优势比(odds ratio,OR)=0.30,95%CI为(0.09,0.95),P=0.04]和脑脊液漏发生率[OR=0.30,95%CI为(0.09,0.95),P=0.04]均明显低于高速磨钻组。结论:在颈椎后路单开门椎管扩大成形术中应用超声骨刀安全有效,可以节约手术时间、减少术中出血量和术后引流量、降低硬脊膜撕裂和脑脊液漏的风险。

Objectives:To evaluate the efficacy and safety of ultrasonic bone curette(UBC)versus high-speed drill(HSD)in cervical expansive open-door laminoplasty(CEOL)by a Meta-analysis approach.Methods:An extensive computer search was conducted in the database of PubMed,Embase,Web of Science,Wanfang and CNKI,and a comparative clinical study comparing the efficacy and safety of UBC versus HSD in cervical expansive open-door laminoplasty was collected.The retrieval period is from the beginning of database building to March 2021.Two researchers independently screened the literature,extracted data,and assessed the risk of bias included in the study,then performed a meta-analysis using the Revman 5.3 software provided by the Cochrane Library.Results:A total of 631 patients were ultimately included in 8 clinical trials,including 4 randomized controlled trials(RCT)and 4 cohort studies(CS),of which 314 were in the UBC group and 317 were in the HSD group.Meta-analysis showed that there was no significant difference in JOA score,VAS score,overall complication rate,axial symptom and C5 nerve root palsy rate between the two groups(P>0.05).However,compared with the HSD group,the UBC group had surgery time[mean difference(MD)=-24.78,95%CI(-36.80,-12.76),P<0.0001],intraoperative bleeding volume[MD=-69.94,95%CI(-115.40,-24.47),P=0.003],postoperative drainage flow[MD=-53.21,95%CI(-86.95,-19.46),P=0.002],incidence of dural tear[OR=0.30,95%CI(0.09,0.95),P=0.04]and incidence of cerebrospinal fluid leakage[odds ratio(OR)=0.30,95%CI(0.09,0.95),P=0.04]were significantly lower than those of the HSD group.Conclusions:It is safe and effective to use UBC in cervical expansive open-door laminoplasty,which can save operation time,reduce blood loss and postoperative drainage,reduce the risk of dural tear and cerebrospinal fluid(CSF)leak.