颈椎人工椎间盘置换与椎间盘切除融合术后邻近节段退变比较研究的Meta分析

发布时间：2018-05-05 03:27

  本文选题：颈椎人工间盘置换术 + 颈前路椎间盘切除融合术　； 参考：《中国脊柱脊髓杂志》2017年04期

【摘要】：目的 :通过Meta分析系统评价颈椎人工间盘置换术(cervical total disc replacement,TDR)与颈前路椎间盘切除融合术(anterior cervical discectomy and fusion,ACDF)对邻近节段退变(adjacent segment degeneration,ASDeg)、邻近节段病(adjacent segment disease,ASDis)发生的影响。方法 :根据Cochrane系统评价指南,通过Pub Med、Medline、EMBASE、Cochrane图书馆、中国生物医学文献数据库(CBM)和万方数据库(Wanfang Database)检索2002年1月~2016年6月之间关于TDR和ACDF术后出现ASDeg、ASDis的随机对照试验(randomized controlled trials,RCTs),由两名研究人员独立筛选文章。纳入文献的方法学质量和偏倚风险通过Cochrane系统评价指南进行评价,提取数据包括ASDeg、ASDis以及再手术率的相关信息,研究结果以ASDeg和ASDis的发生作为直接结果,以邻近节段再手术率作为间接结果评估邻近节段病变的发生,并根据随访时间和研究地点分层进行亚组分析,最终对整篇Meta分析通过证据质量分级和推荐强度系统(the grades of recommendation,assessment,development and evaluation,GRADE)进行质量评估。结果 :共纳入了11篇RCTs,包括2632名研究对象。对于整体的ASD(包括直接和间接结果),TDR的发生率明显低于ACDF(OR=0.6;95%CI[0.38,0.73];P0.00001),差异有统计学意义。ASDeg和再手术率方面,TDR相对于ACDF具有明显优势(分别为OR=0.58,95%CI[0.46,0.72],P0.00001和OR=0.52,95%CI[0.30,0.87],P=0.01)。以随访时间5年为分界点,不论随访5年还是≥5年,在ASDeg发生率上,TDR的优势都比ACDF显著(分别为OR=0.63,P=0.001;OR=0.49,P=0.0002),并且这种优势可能随时间延长有扩大趋势。以研究地点分层,不论在美国(7篇RCTs)还是中国(4篇RCTs),TDR在邻近节段退变(ASDeg)发生率上均有优势(P0.0001,P=0.03)。根据GRADE评分,该Meta分析的质量级别为中等质量。结论:与ACDF相比,TDR在降低ASDeg和再手术率方面具有优势。
[Abstract]:Objective: to evaluate the effect of cervical total disc replacement (TDR) and anterior cervical discectomy and fusion (ACDF) on the occurrence of adjacent segment degeneration segment degenerative ASDega by Meta analysis system. Methods: according to the Cochrane system evaluation guidelines, the Pub Medline was used for the EMBASE Cochrane Library. Chinese Biomedical Literature Database (CBM) and Wanfang Database (Wanfang Database) were collected from January 2002 to June 2016. Randomized controlled trialsrcts were selected by two researchers. The methodological quality and bias risks included in the literature were evaluated through the Cochrane system evaluation guidelines, and data were extracted, including information on ASDegis and the rate of reoperation. The results of the study were based on the occurrence of ASDeg and ASDis. The rate of reoperation of adjacent segments was used as an indirect result to evaluate the occurrence of adjacent segment lesions, and subgroup analysis was performed based on follow-up time and site stratification. Finally, the whole Meta analysis was evaluated by using the grades of recommendation assessment and evaluation system and the evidence quality grading system. Results: 11 RCTs were included, including 2632 subjects. For the whole ASD (including direct and indirect results), the incidence of TDR was significantly lower than that of ACDF OR0.695CI [0.380.73] or P0.00001. The difference was statistically significant. ASDeg and the rate of reoperation were significantly superior to ACDF (OR0.5895CI [0.460.72] P0.00001 and OR0.529595 CI [0.300.87]). Taking 5 years of follow-up as the dividing point, whether for 5 years or 鈮，

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