钛板与丝线悬吊固定在颈椎后路单开门椎管扩大成形中应用的Meta分析  

Micro-titanium plate fixation versus suture suspension fixation in cervical posterior expansive open-door laminoplasty: a meta-analysis

作　　者：阮文枫 金祺[1] 刘辉[1] 王文达[1] 李景峰[1] 冯帆[1] 平安松[1] 

机构地区：[1]武汉大学中南医院,湖北省武汉市430071

出　　处：《中国组织工程研究》2015年第39期6390-6396,共7页Chinese Journal of Tissue Engineering Research

摘　　要：背景:目前有关颈椎后路单开门椎管扩大成形中微型钛板固定与丝线悬吊固定比较的文献较多,但大多研究的样本量存在局限,对于微型钛板应用的优缺点缺乏客观评价。目的:系统评价颈椎后路单开门椎管扩大成形中微型钛板固定与传统丝线悬吊固定对颈椎疾患的修复效果和安全性。方法:由2名评价员检索中/英文公开发表的随机对照试验。计算机检索the Cochrane Central Register of Controlled Trials(CENTRAL)、Pub Med、EMbase、the ISI Web of Knowledge Database、CNKI、CMB、VIP、万方数据库公开发表的有关颈椎后路单开门椎管扩大成形中微型钛板固定与传统丝线悬吊固定的随机对照试验。检索时间均为建库时间至2015年3月1日。同时,手检纳入文献的参考文献。Meta分析采用Cochrane协作网提供的Rev-Man 5.3软件进行。结果与结论:共纳入9个研究,642例患者。Meta分析结果显示:1在安全性方面:两组手术时间[SMD=-0.02,95%CI(-0.57,0.54),P=0.95>0.05]、术中出血量[SMD=0.07,95%CI(-0.26,0.40),P=0.69>0.05]差异无显著性意义。2在有效性方面:与传统丝线悬吊固定相比,微型钛板固定术后JOA评分较高[SMD=0.26,95%CI(0.10,0.42),P=0.001<0.05]、椎板开门角度较大[SMD=0.25,95%CI(0.02,0.48),P=0.04<0.05]、颈椎曲度维持较好[SMD=0.46,95%CI(0.27,0.65),P<0.000 01]、轴性症状发生率较低[RR=0.40,95%CI(0.29,0.56),P<0.000 01]。提示临床上采用单开门椎板扩大成形修复颈椎病时,使用微型钛板固定与丝线悬吊固定均能取得较好的临床效果,但微型钛板固定组在JOA评分、椎板开门角度方面优于丝线悬吊固定组,并能有效的防止颈椎曲度丢失及降低轴性症状的发生率;但因原始研究质量不高,样本不大,建议临床上谨慎使用,尚需要更多高质量大样本的随机对照试验进一步论证。BACKGROUND： Many studies concern the comparison of micro-titanium plate fixation and suture suspension fixation during cervical posterior expansive open-door laminoplasty, but the sample size of many studies has limitations. There is lack of objective evaluation on advantages and disadvantages of micro-titanium plate. OBJECTIVE： To systemically evaluate the efficacy and safety of micro-titanium plate fixation versus suture suspension fixation in cervical posterior expansive open-door laminoplasty. METHODS： English and Chinese randomized controlled trials were searched by two reviewers. They retrieved the Cochrane Central Register of Controlled Trials（CENTRAL）, Pub Med, EMbase, the ISI Web of Knowledge Database, CNKI, CMB, VIP and Wanfang database for randomized controlled trials addressing micro-titanium plate fixation versus suture suspension fixation in cervical posterior expansive open-door laminoplasty published from database foundation to March 1, 2015. The references were also searched by hand. Meta-analyses were performed by using the Rev-Man 5.3 software, provided by the Cochrane Collaboration. RESULTS AND CONCLUSION： A total of 9 studies involving 642 patients were included. The results of meta-analyses showed that：（1） safety： There were no significant differences between the two groups in operation time [SMD=-0.02, 95%CI（-0.57, 0.54）, P=0.95 0.05], and intraoperative blood loss [SMD=0.07, 95%CI（-0.26, 0.40）, P=0.69 0.05].（2） Efficacy： compared with suture suspension fixation, Japanese Orthopaedic Association Scores were higher [SMD=0.26, 95%CI（0.10, 0.42）, P=0.001 0.05], the angle of the opened laminae was bigger [SMD=0.25, 95% CI（0.02, 0.48）, P=0.04 0.05], cervical curvature was better [SMD=0.46, 95% CI（0.27, 0.65）, P〈0.000 01], and incidence of axial symptoms was lower [RR=0.40, 95% CI（0.29, 0.56）, P〈0.000 01] after micro-titanium plate fixation. These findings suggest that during expansive open-door laminoplasty for treatment of cervical spondylos

关 键 词：颈椎 内固定器 META分析 循证医学 骨科植入物 脊柱植入物 颈椎病 微型钛板固定 丝线悬吊固定 单开门 

分 类 号：R318[医药卫生—生物医学工程]