颈椎后路单开门椎管扩大成形跳跃式与连续性微型钛板固定治疗多节段脊髓型颈椎病的Meta分析  

Mini-titanium pla tes alternative-level versus all-level fixation in unilateral open-door laminoplasty through cervical posterior approach for treatment of multisegment cervical spondylotic myelopathy:a meta-analysis

作　　者：罗金峰 秋曙祎 王志民 王太红 LUO Jinfeng;QIU Shuyi;WANG Zhimin;WANG Taihong(The First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450000,Henan,China;Shangqiu Hospital of Traditional Chinese Medicine,Shangqiu 476000,Henan,China)

机构地区：[1]河南中医药大学第一附属医院,河南郑州450000 [2]商丘市中医院,河南商丘476000

出　　处：《中医正骨》2023年第10期31-36,共6页The Journal of Traditional Chinese Orthopedics and Traumatology

摘　　要：目的:系统评价颈椎后路单开门椎管扩大成形跳跃式与连续性微型钛板固定治疗多节段脊髓型颈椎病(cervical spondylotic myelopathy,CSM)的优劣。方法:通过计算机检索中国知网、万方数据库、维普网、中国生物医学文献服务系统、PubMed、Web of Science、Embase、Cochrane Library中有关颈椎后路单开门椎管扩大成形跳跃式与连续性微型钛板固定治疗多节段CSM对比研究的文献,检索时限均为建库至2022年11月10日。跳跃固定组和连续固定组分别采用颈椎后路单开门椎管扩大成形跳跃式与连续性微型钛板固定治疗。由2名研究人员独立筛选文献、提取数据并评价纳入研究的偏倚风险后,采用RevMan5.4软件进行Meta分析。结果:共纳入12项研究,其中非随机干预性研究11项、随机对照试验1项;共涉及1037例患者,其中跳跃固定组528例、连续固定组509例。Meta分析结果显示,2组患者末次随访时日本骨科学会评分、神经功能改善率、术后颈椎曲度、术后颈椎活动度、C5神经根麻痹和轴性症状发生率、住院时间的组间差异均无统计学意义;与连续固定组相比,跳跃固定组的手术时间更短[SMD=-0.33,95%CI(-0.57,-0.08)]、术中出血量更少[SMD=-0.29,95%CI(-0.50,-0.09)]、住院费用更低[SMD=-5.42,95%CI(-7.07,-3.78)]。11项研究报告了再关门现象,至末次随访时2组均未发生再关门现象;其中2项研究比较了跳跃固定组未使用钛板固定节段与连续固定组对应节段末次随访时的椎板开口角度,Meta分析结果显示跳跃固定组对应节段的椎板开口角度小于连续固定组[MD=-2.57,95%CI(-3.34,-1.81),P=0.000]。针对末次随访时日本骨科学会评分的漏斗图基本对称,提示存在发表偏倚的可能性较小。结论:现有的证据表明,颈椎后路单开门椎管扩大成形跳跃式与连续性微型钛板固定治疗多节段CSM的疗效和安全性相当,但跳跃式微型钛板固定的手术时间�Objective:To systeratically review the superiority and inferiority of mini titanium plates alternative-level versus al-level fixation in urilateral open-door lamninoplasty through cervical posterior approach for treatmnent of mulise gment cervical spondylotic myelopathy(CSM).Methods:All the comparative study articles about mini-titanium plates altermativ-level(alterative-level fixation group)versus all-level fixation(11-level fixstion group)in unilateral open-door laminoplasty through cervical posterior approach for tre atment of multiegment CSM included from database establishing to November 10,2022 were retrieved from China National Knowledge Internet,w anfang Database,Vip Dat abase,Chinese Biomnedical literature Service Systerm,PubMed,Web of Science,Embase and Cochrane Library through computer.The patients in alternative-level fxation group and alevell fixation group were treated with mini-tita nium plates altermative-level and 11-level fixation in unilateral open-door lamninoplasty through cervical posterior approach respectively.The articles were screened and the information was extracted independently by two researchers according to the inclusion and exclusion criteria.The methodological quality of research in the articles was ev aluated respectively independently by the same two researchers,and if any disagreement was found between them,discussion was conducted for making a final decision,and then a Meta-analysis was conducted by using RevMan5.4 software.Results:Twelve articles(1037 patients)were included in the final analysis,including 11 non-randomi zed itervention study articles,and 1 randomizxed cotolled trial(RCT)article.Five hundred and twenty-eight patients in alternative-level fix ation group,and 509 ones in 11-level fixation group.The results of Meta-analysis revealed that,at the last follow-up,there was no statistical difference in Japanese Orthopaedic Association(JOA)score,improvement rate of neurological function,postoperative cervical curvature,postoperative cervical range of motion,incidence

关 键 词：椎板成形术 脊髓型颈椎病 骨板 跳跃式固定 连续性固定 专题Meta分析 

分 类 号：R687.3[医药卫生—骨科学]