后颅窝减压及硬膜成形术与单纯后颅窝减压术比较治疗Ⅰ型Chiari畸形效果的Meta分析  

Comparison of Posterior Fossa Decompression with and without Duraplasty for Surgical Treatment of Chiari Malformation Type Ⅰ:A Meta-Analysis

作　　者：张豆豆[1] 陈海锋[1] 黄思庆 郝德[1] 任海波[1] 汤俊佳[1] 

机构地区：[1]四川大学华西医院神经外科,成都610041

出　　处：《中国循证医学杂志》2012年第9期1090-1097,共8页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价后颅窝减压及硬膜成形术(PFDD)与单纯后颅窝减压(PFD)两种术式比较治疗Ⅰ型Chiari畸形的有效性和安全性。方法计算机检索CENTRAL、Science Citation Index Expanded、MEDLINE(Ovid)、PubMed、CBM、CNKI和WanFang Data,收集比较后颅窝减压及硬膜成形术(PFDD)与单纯后颅窝减压(PFD)治疗Ⅰ型Chiari畸形有效性和安全性的文献,并辅以检索纳入研究的参考文献。检索时限均从1993年至2011年9月。由2位评价者按照纳入和排除标准独立选择文献,提取资料,采用Newcastle-Ottawa量表对纳入研究进行方法学质量评价,然后采用RevMan 5.1软件对数据进行Meta分析,并采用GRADE系统评价证据质量评价。结果共纳入10个队列研究,829例患者。Meta分析结果显示:①PFDD组再手术率低于PFD组[RR=0.41,95%CI(0.23,0.74),P=0.003],PFDD组术后脊髓空洞缩小率高于PFD组[RR=1.27,95%CI(1.03,1.56),P=0.02],术后临床症状改善两组差异无统计学意义[RR=1.11,95%CI(0.95,1.28),P=0.18]。②PFDD组术后脑脊液相关并发症发生率显著高于PDF组[RR=6.3,95%CI(2.71,14.67),P<0.000 1],而术后枕部疼痛及伤口感染发生率两组差异均无统计学意义(P>0.05)。基于上述系统评价结果,采用GRADE系统评价证据质量及推荐等级,证据总体质量评级为低质量,推荐强度为弱推荐。结论与PFD相比,PFDD可减少再次手术率,提高脊髓空洞缩小率,但会显著增加脑脊液相关并发症发生的风险。受纳入研究质量较低等因素影响,上述结论尚需更多高质量、大样本的RCT进一步加以验证。我们建议临床上根据患者情况,个性化选择使用。Objective To systematically evaluate posterior fossa decompression with duraplasty （PFDD） and pos- terior fossa decompression without duraplasty （PFD） for Chiari malformation type Ⅰ（CM-I）. Methods A meta-analysis was performed according to the guideline of the MOOSE statement. Relevant literature and references were electronically searched in CENTRAL, Science Citation Index Expanded, MEDLINE （Ovid）, PubMed, CBM, CNKI and WanFang Data from 1993 to September 2011. Two reviewers independently identified literature according to inclusion and exclusion criteria. The included studies were evaluated using the Newcastle-Ottawa Scale. Original data were extracted and analyzed using RevMan 5.1 software. Besides, the level of evidence was assessed using the GRADE system. Results Ten studies involving 829 patients were included. The results of meta-analyses showed that： a） compared with patients undergoing PFD, patients undergoing PFDD had a significantly lower reoperation rate （RR=0.41, 95%CI 0.23 to 0.74, P=0.003）, and a higher rate of syringomyelia decrease （RR=1.27, 95%CI 1.03 to 1.56, P=0.02）. But there was no significant difference in clinical improvement （RR= 1.11, 95%CI 0.95 to 1.28, P=0.18）. b） compared with PFD, patients undergoing PFDD had a higher rate of cerebrospinal fluid-related complications （RR-6.3, 95%CI 2.71 to 14.67, P〈0.000 1）. There were no signifi- cant differences in the complication of occipital neuralgia and wound infection （P〉0.05）. Based on GRADE system, the evidence was at Level C and we made a weak recommendation. Conclusion Posterior fossa decompression with dura- plasty is associated with a lower risk of reoperation, a better effect of syringomyelia decrease and a greater risk for cerebro- spinal fluid-related complications, compared with PFD. Due to the influencing factors of lower-quality included studies, a prudent choice is suggested, and also more high-quality, large-sample studies are need.

关 键 词：Ⅰ型Chiari畸形 硬膜成形术 META分析 系统评价 队列研究 

分 类 号：R651.1[医药卫生—外科学]