| 董亮,许正伟,刘世长,王栋琪,孙宏慧,陈秀锦,郝定均,钱立雄*.颈椎椎间盘置换术与前路颈椎椎间盘切除融合术对相邻节段病变参数影响的荟萃分析[J].脊柱外科杂志,2020,18(1):38-47. |
颈椎椎间盘置换术与前路颈椎椎间盘切除融合术对相邻节段病变参数影响的荟萃分析  点此下载全文 (Fulltext) |
| 董亮 许正伟 刘世长 王栋琪 孙宏慧 陈秀锦 郝定均 钱立雄* |
| 西安交通大学附属红会医院脊柱外科, 西安 710054 |
| 基金项目：2017年陕西省博士后科研项目（2017BSHQYXMZZ20） |
| DOI：10.3969/j.issn.1672-2957.2020.01.009 |
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| 摘要： |
| 目的 对颈椎椎间盘置换术（CDA）和前路颈椎椎间盘切除融合术（ACDF）在相邻节段退行性变（ASDeg）、相邻节段疾病（ASDis）、相邻节段再手术（ASR）及相邻节段活动度（ROM）的影响方面进行荟萃分析。方法 检索PubMed、Medline、EMbase及Cochrane图书馆等数据库，检索文献为2018年6月前发表的CDA与ACDF的随机对照研究（RCT），采用Cochrane系统评价指南的评分量表对纳入文献的随机方法和偏倚进行评估。主要提取的数据包括随访时间，ASDeg、ASDis和ASR发生率，相邻节段ROM。同时采用亚组分析和敏感性分析研究其高异质性。结果 共33篇RCT文献纳入研究。CDA组ASR发生率明显低于ACDF组，差异有统计学意义（P<0.05）；以随访时间进行亚组分析显示，随着随访时间延长，CDA组ASR发生率下降的优势增加。2年内2组的ASDeg发生率差异无统计学意义，2年后CDA组ASDeg发生率明显低于ACDF组，差异有统计学意义（P<0.05）。2组的ASDis发生率差异无统计学意义。CDA组相邻节段ROM低于ACDF组，但差异无统计学意义。结论 相较于ACDF，CDA可降低ASDeg和ASR发生率，但在ASDis发生率和相邻节段ROM方面二者差异无统计学意义。 |
| 关键词：颈椎 椎间盘退行性变 椎间盘切除术 假体和植入物 荟萃分析 |
| Effect of cervical disc arthroplasty and anterior cervical discectomy and fusion on parameters of adjacent segment lesion: a meta-analysis Fulltext |
| DONG Liang XU Zheng-wei LIU Shi-chang WANG Dong-qi SUN Hong-hui CHEN Xiu-jin HAO Ding-jun QIAN Li-xiong* |
| Department of Spinal Surgery, Honghui Hospital, Xi'an Jiaotong University Medicine College, Xi'an 710054, Shaanxi, China |
| Fund Project: |
| Abstract: |
| Objective To analyze the effects of cervical disc arthroplasty(CDA) and anterior cervical discectomy and fusion (ACDF) on adjacent segment degeneration (ASDeg), adjacent segment disease (ASDis), adjacent segment reoperation (ASR) and adjacent segment range of motion (ROM) using meta analysis. Methods PubMed, Medline, EMbase, Cochrane Library and other databases were searched for randomized controlled studies(RCT) comparing CDA and ACDF published before June 2018. Randomized methods and deviations were evaluated by the score scale provided by the evaluation guidelines for Cochrane system. The main extracted data included follow-up time, incidences of ASDeg, ASDis and ASR, adjacent segment ROM. High heterogeneity was studied by subgroup analysis and sensitivity analysis. Results A total of 33 RCTs were included in the analysis. The incidence of ASR in the CDA group was significantly lower than that in the ACDF group, and the difference was statistically significant (P<0.05). Subgroup analysis based on follow-up time showed that with the extension of follow-up time, the advantage of decreasing ASR incidence increased in the CDA group. There was no statistically significant difference in the incidence of ASDeg between the 2 groups within 2 years, and the incidence of ASDeg in the CDA group was significantly lower than that in the ACDF group after 2 years, with statistically significant difference (P<0.05). There was no statistically significant difference in the incidence of ASDis between the 2 groups. ROM of adjacent segments in the CDA group was lower than that in the ACDF group, but the difference was not statistically significant. Conclusion Compared with ACDF, CDA can reduce the in cidence of ASDeg and ASR, but there is no statistical difference in the incidence of ASDis and ROM of adjacent segment. |
| Keywords:Cervical vertebrae Intervertebral disc degeneration Diskectomy Prostheses and implants Meta-analysis |
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