颈前板限制性和非限制性固定早期融合效果的比较  

Comparison of the effect on the early fusion of constrained fixation and unconstrained fixation in anterior cervical plate system

作　　者：田伟[1] 孙宇庆[1] 陈志刚[2] 崔岩峥[2] 蔡宝春 许小波 Tian Wei;Sun Yuqing;Chen Zhigang;Cui Yanzheng;Cai Baochun;Xu Xiaobo(Department of Spine Surgery,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院脊柱外科,北京100035 [2]北京积水潭医院临床试验中心,北京100035 [3]浙江德康医疗技术研发中心,嘉兴314031

出　　处：《骨科临床与研究杂志》2018年第5期282-288,共7页Journal Of Clinical Orthopedics And Research

基　　金：北京市医院管理局"使命"人才计划(SML20150401)~~

摘　　要：目的通过Meta分析和综述比较的方法探讨颈前板限制性和非限制性2种固定方式对术后早期融合效果的影响。方法应用循证医学的方法在中英文数据库中系统检索颈前板限制性固定与非限制性固定早期融合率的相关文献,文献发表时间为2000年1月至2017年7月。英文数据库包括Embase数据库、Clinical Trial数据库、PubMed数据库、Cochrane Library数据库以及Springer Link数据库等,检索词包括"anterior cervical plate"、"fusion"、"static"、"dynamic"、"lock"、"non-lock"、"fixed"、"variable"、"constraint"、"unconstraint"、"restriction"和"non-restriction"。中文数据库包括CHKD期刊全文数据库(CNKI)、万方医学期刊数据库(万方)、中国生物医学文献数据库(CBM)等,检索词包括"颈"、"颈椎"、"前路"、"固定"、"动态"、"活动"、"静力"、"动力"、"限制""非限制"、"板"和"融合"等。采用STATA 14.2统计学软件对文献中报道的术后早期(4~9个月)融合率进行Meta分析。结果共纳入文献8篇,包括5篇英文文献和3篇中文文献。8篇文献报道的病例中,限制性固定组230例,非限制性固定组253例。Meta分析结果显示,术后平均6.8个月限制性和非限制性固定早期融合率的区间分别为95%CI:64.27%~100%和95%CI:69.48%~97.32%,2种固定方式的融合率差异无统计学意义(P>0.05)。对纳入的文献进行异质性检验,发现OR=1.35>1,无异质性,且无发表偏倚,敏感性分析结果可靠。结论颈前板限制性和非限制性固定在促进植骨融合和提高术后早期融合率方面差异不显著。Objective To compare the effect on the early fusion of constrained fixation and unconstrained fixation in anterior cervical plate system by using various statistical methods.MethodsThe related literatures in English and Chinese published between January 2000 and July 2017 were systematically searched.The English databases included Embase,Clinical Trial,PubMed,Cochrane Library,Springer Link,etc.Keywords related to the study included＂anterior cervical plate＂,＂fusion＂,＂static＂,＂dynamic＂,＂lock＂,＂nonlock＂,＂fixed＂,＂variable＂,＂constraint＂,＂unconstraint＂,＂restriction＂and＂non-restriction＂.The Chinese databases included CNKI,Wanfang,Chinese Biomedical Literature,etc.STATA 14.2 version was used for Meta-analysis to compare the early fusion rates at 4-9 months postoperatively.Results A total of 8 articles（5 English articles and 3 Chinese articles）were included.Of these reported cases,230 patients were in constrained fixation group,and 253 patients were in unconstrained fixation group.Mete-analysis showed that at average 6.8 months after surgery,the fusion rates of constrained fixation and unconstrained fixation were not significant different（95%CI：64.27%-100%vs.95%CI：69.48%-97.32%,P〉0.05）.The included literatures were found with no heterogeneity（OR=1.35〉1）and no publication bias,and the results of sensitivity analysis were reliable.Conclusion Constrained fixation and unconstrained fixation of the anterior cervical plate are not significantly different in promoting bone graft fusion and improving early postoperative fusion rate.

关 键 词：颈椎 骨折固定术 内 外科固定设备 META分析 

分 类 号：R687.3[医药卫生—骨科学]