后路椎板切除螺钉内固定与椎管扩大成形治疗多节段脊髓型颈椎病的Meta分析

发布时间：2018-05-28 12:36

本文选题：颈椎 + Meta分析　；参考：《中国组织工程研究》2017年03期

【摘要】：背景:目前有关后路椎板切除螺钉内固定与椎管扩大成形治疗多节段脊髓型颈椎病疗效比较的文献较多,但研究的样本量存在局限,对于两者的优缺点缺乏客观评价。目的:系统评价后路椎板切除螺钉内固定与椎管扩大成形治疗多节段脊髓型颈椎病的临床疗效与安全性。方法:应用计算机检索Pub Med、Cochrane Central、EMbase、the ISI Web of Knowledge Database、CMB、CNKI、维普及万方数据库,纳入关于后路椎板切除内固定与椎管扩大成形治疗多节段脊髓型颈椎病疗效比较的随机或非随机对照试验。采用Rev-Man 5.3软件对两种治疗的术后JOA评分、术后颈椎活动度、术后颈椎曲度指数、术后C5神经根麻痹发生率及术后轴性症状发生率进行Meta分析。结果与结论:(1)共纳入14篇研究,1 024例患者,其中椎板切除螺钉内固定组519例,椎管扩大成形组505例;(2)Meta分析结果显示,椎板切除螺钉内固定组C5神经根麻痹发生率高于椎管扩大成形组[RR=2.24,95%CI(1.33,3.75),Z=3.05,P0.05],术后颈椎活动度低于椎管扩大成形组[SMD=-0.71,95%CI(-2.21,-1.2),Z=6.63,P0.05];两组术后JOA评分、颈椎曲度指数、轴性症状发生率比较差异无显著性意义;(3)结果提示,后路椎板切除螺钉内固定与椎管扩大成形治疗多节段脊髓型颈椎病均有一定疗效,但后路椎管扩大成形对颈椎活动功能损伤小且术后C5神经根麻痹的发生率低,有一定优势,但在临床诊疗过程中仍需结合患者病情综合判断,其远期的疗效有待更进一步的临床研究。
[Abstract]:Background: there are many literatures about posterior laminectomy and screw fixation and spinal canal enlargement in the treatment of multilevel cervical Spondylotic myelopathy. However, the sample size of the study is limited and there is no objective evaluation of their advantages and disadvantages. Objective: to evaluate the efficacy and safety of posterior laminectomy and screw fixation and spinal canal enlargement in the treatment of multilevel cervical Spondylotic myelopathy. Methods: a computerized search was conducted to retrieve the ISI Web of Knowledge Database CMB CNKI, Weip and Wanfang databases of Pub Meda Cochrane Central EMbase, and to include in a randomized or non-randomized controlled trial the comparison of posterior laminectomy and internal fixation with extended spinal canal plasty in the treatment of multilevel cervical Spondylotic myelopathy. Rev-Man 5.3 software was used to analyze the postoperative JOA score, postoperative cervical movement, postoperative cervical curvature index, postoperative C5 nerve root paralysis rate and postoperative axial symptom rate by Meta. Results 1 024 patients were included in 14 studies, including 519 cases in laminectomy and screw fixation group and 505 cases in enlarged spinal canal formation group. The incidence of C5 nerve root paralysis in laminectomy and screw fixation group was higher than that in enlarged spinal canal plasty group [RRRN 2.2495CII 1.33 ~ 3.75], and the postoperative cervical movement was lower than that in the extended spinal canal plasty group [SMD-0.71-95CI-2.21- 1.2Z 6.63]; JOA score, cervical curvature index, cervical curvature index after operation in both groups were higher than those in the control group (P < 0.05). The results showed that posterior laminectomy and screw fixation and spinal canal enlargement were effective in the treatment of multilevel cervical Spondylotic myelopathy. But the posterior spinal canal enlargement has little injury to the cervical vertebrae movement function and the incidence of C5 nerve root paralysis is low, which has some advantages. But in the course of clinical diagnosis and treatment, it is still necessary to combine with the comprehensive judgment of the patient's condition. Its long-term effect needs further clinical research.
【作者单位】：武汉大学中南医院骨科;
【分类号】：R687.3

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