选择性脊神经后根切断术对不同粗大运动功能分级系统等级脑性瘫痪患者疗效及安全性的Meta分析

A Meta-analysis in efficacy and safety of selective posterior rhizotomy for patients with cerebral palsy at different grades of the Gross Motor Function Classification System

目的探讨选择性脊神经后根切断术(SPR)治疗不同粗大运动功能分级系统(GMFCS)等级脑性瘫痪患者的疗效与安全性差异。方法检索Pubmed、Embase、Web of Science、中国生物医学文献数据库、中国期刊全文数据库(CNKI)、万方数据库、维普数据库中相关文献,纳入有关SPR治疗脑性瘫痪的临床试验研究进行Meta分析。由至少2名研究员独立筛选文献、提取数据和评估文献质量,数据分析采用Review Manager 5.4软件。结果共检索到2726篇文献,经过筛选最终纳入8篇。Meta分析结果显示,GMFCS各级脑性瘫痪患者的粗大运动能力、自理能力在术后均改善,肌张力在术后均下降,差异有统计学意义(P<0.05)。对比SPR术前和术后的粗大运动能力改善情况,Ⅱ级、Ⅲ级患者获益最佳,其次为Ⅰ级患者,Ⅳ级、Ⅴ级患者获益较少;在提高自理能力方面,Ⅰ级患者获益最佳,其次为Ⅲ级患者,Ⅱ级、Ⅳ级患者获益较小。既往文献均未报告明显不良反应。结论SPR对于脑性瘫痪患者是相对安全且有效的治疗方案。GFMCSⅡ、Ⅲ级患者SPR的获益最佳,术前身体状态较差的GFMCSⅣ、Ⅴ级患者也能从中获益。

Objective To investigate the differences in efficacy and safety in the treatment of patients with cerebral palsy at different grades of the Gross Motor Function Classification System(GMFCS)by selective posterior rhizotomy(SPR).Methods Relevant literatures on SPR treatment for cerebral palsy were retrieved from Pubmed,Embase,Web of Science,China Biology Medicine disc,China National Knowledge Infrastructure(CNKI),Wanfang Database,and VIP Database.Clinical trials on SPR treatment for cerebral palsy were included for Meta-analysis.At least two researchers independently screened the literatures,extracted data,and assessed the quality of the literatures.Data analysis was performed by Review Manager 5.4 software.Results A total of 2,726 literatures were retrieved,and 8 literatures were finally included after screening.The results of the Meta-analysis showed that the gross motor function and self-care ability of patients with cerebral palsy at all GMFCS grades improved significantly after surgery,and muscle tone decreased significantly after surgery(P<0.05).In comparison of the improvement in gross motor function before and after SPR,patients with gradesⅡandⅢof GMFCS benefited the most,followed by those with gradeⅠ,and those with gradesⅣand V benefited less.In terms of improving self-care ability,patients with gradeⅠbenefited the most,followed by those with gradeⅢ,and those with gradesⅡand IV benefited less.No significant adverse reactions were reported in previous literatures.Conclusion SPR is a relatively safe and effective treatment option for patients with cerebral palsy.Patients at gradesⅡandⅢof GMFCS benefit the most from SPR,and patients at gradesⅣand V with poor preoperative physical status can also benefit from SPR.