椎前路减压零切迹融合器与传统钉板系统内固定治疗颈椎病的Meta分析  

Zero profile anterior cervical interbody fixation system and traditional cervical plate internal fixation for cervical spondylosis: A meta-analysis

作　　者：李康[1] 许少策 王诗尧 岳海源[1] 雷栓虎[1] 刘京升[1] 汪玉良[1] LI Kang;XU Shao-ce;WANG Shi-yao;YUE Hai-yuan;LEI Shuan-hu;LIU Jing-sheng;WANG Yu-liang(Department of Orthopedics,Second Hospital of Lanzhou University,Lanzhou 700030,China)

机构地区：[1]兰州大学第二医院骨科,兰州730030

出　　处：《解放军医学杂志》2018年第11期956-967,共12页Medical Journal of Chinese People's Liberation Army

摘　　要：目的系统评价椎前路减压融合时零切迹融合器与传统钉板系统内固定治疗颈椎病的疗效。方法通过计算机检索PubMed、Embase、Cochrane Library、中国期刊全文数据库(CNKI)、万方数据库、维普数据库(VIP),并手工检索中华医学系列杂志相关文献,检索时间为2008年2月-2018年4月。收集所有椎前路减压融合时零切迹融合器与传统钉板系统内固定治疗颈椎病的对照研究,筛选出符合要求的文章,并严格评价纳入研究的方法学质量。采用Cochrane协作网提供的RevMan5.3软件进行Meta分析。纳入分析的指标包括手术时间、术中出血量、术后JOA评分、术后VAS评分、椎间高度、术后吞咽困难、术后前纵韧带骨化、术后颈椎功能障碍指数(NDI)共8项。结果共纳入32篇文献,其中中文文献12篇,英文文献20篇,共包含2154例患者,零切迹椎前融合器组1044例,传统钉板系统内固定组1110例。Meta分析结果显示,与传统钉板系统内固定相比,零切迹椎前融合器组术后吞咽困难发生率低[OR=0.36,95%CI(0.28,0.47),P<0.00001]、术后前纵韧带骨化发生率低[OR=0.09,95%CI(0.02,0.38),P=0.001]。而在术后JOA评分[WMD=–0.02,95%CI(–0.12,0.09),P=0.76]、术后VAS评分[WMD=0.02,95%CI(–0.10,0.15),P=0.72]、术后NDI指数[WMD=–0.14,95%CI(–0.44,0.16),P=0.35]、术后椎间高度[WMD=0.04,95%CI(–0.03,0.12),P=0.25]方面两组比较差异无统计学意义。而在手术时间、术中出血量方面由于异质性过大,本研究采用了描述性分析,还需进一步研究探讨。结论与传统钉板系统内固定相比,零切迹椎前融合器具有术后吞咽困难及前纵韧带骨化发生率低的优点,而术后JOA评分、VAS评分、NDI指数、椎间高度方面二者效果类似。Objective To evaluate the efficacy of zero profile anterior cervical interbody fixation system(ZPFS) and traditional cervical plate internal fixation for the treatment of cervical spondylosis using a meta-analysis. Methods Related literature was collected by computerized search of online databases including PubMed, Embase, Cochrane Library, CNKI, VIP, and Wanfang and by manual search of the series of Chinese Medical Journals(2008.2-2018.4). Papers that reported controlled trials of ZPFS and cervical plate internal fixation for the treatment of cervical spondylosis were enrolled in this study. The quality of trials was strictly assessed. RevMan5.3 software provided by the Cochrane Collaboration was used for the analysis of data. The eight indexes included operation time, intraoperative bleeding volume, postoperative JOA score, postoperative VAS score, intervertebral height, dysphagia rate, ossification of anterior longitudinal ligament rate, and neck disability index(NDI). Results Thirty-two papers(12 Chinese and 20 English studies) involving 2154 patients(1044 in ZPFS group and 1110 in cervical plate internal fixation group) were finally enrolled. According to the meta-analysis, compared with cervical plate internal fixation, ZPFS had a significantly lower rate of dysphagia(OR=0.36, 95%CI: 0.28 to 0.47, P<0.00001), and a significantly lower ossification rate of anterior longitudinal ligament(OR=0.09, 95%CI: 0.02 to 0.38, P=0.001). There was no significant difference in the JOA score(WMD=–0.02, 95%CI: –0.12 to 0.09, P=0.76), VAS score(WMD=0.02, 95% CI –0.10 to 0.15, P=0.72), intervertebral height(WMD=0.04, 95%CI: –0.03 to 0.12, P=0.25) and NDI(WMD=–0.14, 95%CI: –0.44 to 0.16, P=0.35) after surgery between the two fusion methods(P>0.05). In terms of operation time and intraoperative bleeding volume, the descriptive analysis was adopted in the study due to the heterogeneity among the studies. Further study is needed. Conclusions Compared with the traditional cervical plate internal fixation, ZPFS has the

关 键 词：颈椎病 前路减压融合 零切迹 钉板内固定 META分析 

分 类 号：R681.53[医药卫生—骨科学]