超声骨刀与高速磨钻经颈椎后路减压术治疗CDD有效性及安全性的meta分析

Efficacy and safety of posterior cervical decompression with ultrasonic bone-cuttinge and high speed drill in treatment of cervical degenerative diseases:a meta analysis

目的系统评价超声骨刀(UBC)与高速磨钻(HSD)经颈椎后路减压术治疗颈椎退行性疾病(CDD)的有效性及安全性。方法检索在2021年5月之前公开发表在中国知网(CNKI)、万方数据库、维普中文科技期刊数据库(VIP)、中国生物医学文献数据库(CBM)、PubMed和EMbase等数据库的文献,搜索有关UBC与HSD经颈椎后路减压术治疗CDD的临床文献,由两位评价者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,运用Stata/SE 12.0软件进行meta分析。结果共纳入14项研究,UBC、HSD组患者分别379、427例。Meta分析结果显示,UBC组患者的手术总时间(MD=-20.78,95%CI:-31.68~-9.88)、术中总出血量(MD=-57.97,95%CI:-110.14~-5.81)、术后引流量(MD=-53.69,95%CI:-89.80~-17.59)、并发症发生率(MD=0.52,95%CI:0.32~0.85)、术后视觉模拟评分(VAS,MD=-0.80,95%CI:-1.23~-0.37)均低于HSD组,差异均有统计学意义(P<0.05)。两组日本骨科协会评分(JOA)比较,差异无统计学意义(MD=0.01,95%CI:-0.15~0.17,P>0.05)。结论与HSD相比,在颈椎后路减压术治疗CDD中UBC具有提高减压速度,失血量小、并发症少的优势。

Objective To systematically evaluate the efficacy and safety of posterior cervical decompression with ultrasonic bone-cuttinge(UBC)and high speed drill(HSD)in the treatment of cervical degenerative diseases(CDD).Methods The pub;ished clinical literatures on UBC and HSD in treating CDD via posterior cervical decompression were retrieved from the databases of China National Knowledge Infrastructure(CNKI),Wanfang Database,VIP,China Biomedical Literature Database(CBM),PubMed,Web of Science,EMbase,and the Cochrane Library until May 2021.Two reviewers independently screened the literatures,extracted the data and assessed the risk of bias in the included studies.Then meta-analysis was performed by using Stata/SE 12.0 software.Results A total of 14 studies were included,including 379 patients in the UBC group and 427 patients in the HSD group.The meta analysis results showed that compared with the HSD group,the total surgery time in the UBC group(MD=-20.78,95%CI:-31.68--9.88),total intraoperative bleeding volume(MD=-57.97,95%CI:-110.14--5.81),total postoperative drainage volume(MD=-57.97,95%CI:-110.14--5.81),incidence rate of complications(MD=0.52,95%CI:0.32-0.85)and postoperative visual analogue scale(VAS,MD=-0.80,95%CI:-1.23--0.37)were significantly lower than those in the HSD group,and the differences were statistically significant(P<0.05).However,there was no statistically significant difference in Japan Orthopaedic Association(JOA)scores between the two groups(MD=0.01,95%CI:-0.15-0.17,P>0.05).Conclusion Compared with HSD,UBC has the advantages of improving the decompression speed,less blood loss and less complications in the treatment of CDD by posterior cervical decompression.