不同手术入路治疗下颈椎小关节脱位疗效的系统评价及meta分析

发布时间：2018-06-08 00:43

本文选题：下颈椎 + 小关节脱位　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:由于手术治疗下颈椎小关节脱位的临床预后优于非手术治疗,因此目前普遍采用手术策略来处理下颈椎小关节脱位。手术入路有多种,包括单纯前路、后路以及前后联合入路,但是治疗下颈椎小关节脱位的手术入路选择尚存争议。本文应用系统评价及meta分析的方法评价不同手术入路治疗下颈椎小关节脱位的疗效,以期为下颈椎小关节脱位手术方式的选择提供循证医学的证据支持。方法:计算机检索PubMed(1966年至2016年6月)、EMbase(1974年至2016年6月)、Cochrane图书馆(2016年第6期)、中国生物医学文献数据库(CBM,1978年至2016年6月)、相关期刊论文(CNKI,1994年至2016年6月)及万方数据库(1998年至2016年6月),手工检索相关的中英文骨科杂志和会议论文,收集不同手术入路治疗下颈椎小关节脱位的随机或非随机对照研究,由两名研究者按纳入与排除标准选择文献、提取资料和质量评价后,采用Re Man5.2软件对可以合并分析的指标进行meta分析,对不能合并的指标采用描述性分析。结果:共纳入7篇文献,652例患者,其中前路手术患者290例,后路手术患者151例,前后联合入路患者211例。分析结果显示:前路的手术时间小于后路(WMD=-22.22,95%CI:-34.20~-10.24,P=0.0003)及前后联合入路(WMD=-117.27,95%CI:-132.41~-102.12,P0.00001);前路的出血量小于后路(WMD=-255.33,95%CI:-306.81~-203.85,P0.00001)及前后联合入路(WMD=-402.84,95%CI:-489.59~-316.09,P0.00001);前路与前后联合入路的固定节段无统计学差异(WMD=-1.38,95%CI:-4.18~1.43,P=0.34),但均小于后路(WMD=-1.29,95%CI:-2.16~-0.42,P=0.004);前路的术后椎体水平位移小于后路(WMD=-0.06,95%CI:-0.10~-0.03,P=0.0004)及前后联合入路(WMD=-1.67,95%CI:-2.60~-0.74,P=0.0004);前路与后路的术后Cobb角无统计学差异(WMD=-0.18,95%CI:-0.61~0.26,P=0.42),但小于前后联合入路(WMD=-1.29,95%CI:-2.25~-0.33,P=0.008)。结论:虽然不同手术入路均有较好的临床疗效,但就手术入路本身而言,前路手术的优势较明显。由于存在纳入研究数量及方法学质量的局限性,还需要进行大样本、高质量的随机对照研究以得出更加可信的结论。
[Abstract]:Objective: the surgical treatment of the lower cervical joint dislocation is superior to the non operative treatment. Therefore, the surgical strategy is widely used to deal with the dislocation of the lower cervical spine. There are many surgical approaches, including simple anterior, posterior and combined approach, but the choice of surgical approach for the lower cervical joint dislocation is still controversial. The results of systematic evaluation and meta analysis were used to evaluate the effect of different surgical approaches to the lower cervical joint dislocation to provide evidence-based support for the selection of the operation mode of the lower cervical joint dislocation. Methods: computer retrieval of PubMed (1966 to June 2016), EMbase (1974 to June 2016), Cochrane Library (2) 016 years and sixth years), Chinese biomedical literature database (CBM, 1978 to June 2016), Chinese journal full text database (CNKI, 1994 to June 2016) and Wanfang database (1998 to June 2016), manually retrieving relevant Chinese and English Department of orthopedics magazines and conference papers to collect random or random dislocation of the lower cervical joints under different surgical approaches. In the non randomized controlled study, after two researchers selected the literature, extracted data and quality evaluation according to the inclusion and exclusion criteria, the Re Man5.2 software was used to perform meta analysis on the indexes that could be combined and analyzed. A descriptive analysis was used for the indexes that could not be merged. Results: a total of 7 articles were included and 652 patients, including 290 cases of anterior surgery, and the posterior approach, were included. The results showed that the operative time of the anterior approach was less than that of the posterior approach (WMD=-22.22,95%CI:-34.20~-10.24, P=0.0003) and the anterior and posterior approach (WMD=-117.27,95%CI:-132.41~-102.12, P0.00001). The amount of bleeding in the anterior approach was less than that of the posterior approach (WMD=-255.33,95%CI:-306.81~-203.85, P0.00001) and the combination of anterior and posterior (WMD=-255.33,95%CI:-306.81~-203.85, P0.00001). WMD=-402.84,95%CI:-489.59~-316.09 (P0.00001); there was no statistical difference between the fixed segments of the anterior and anterior anterior and posterior approaches (WMD=-1.38,95%CI:-4.18~1.43, P=0.34), but less than the posterior approach (WMD=-1.29,95%CI:-2.16~-0.42, P=0.004); the horizontal displacement of the vertebral body after the anterior approach was smaller than that of the posterior (WMD=-0.06,95%CI:-0.10~-0.03, P=0.0004) and the anterior and posterior approach (WMD=-0.06,95%CI:-0.10~-0.03, P=0.0004). WMD=-1.67,95%CI:-2.60~-0.74 (P=0.0004); there was no statistical difference between the anterior and posterior approach Cobb angles (WMD=-0.18,95%CI:-0.61~0.26, P=0.42), but less than the anterior and posterior approach (WMD=-1.29,95%CI:-2.25~-0.33, P=0.008). Conclusion: Although different surgical approaches have better clinical efficacy, the anterior approach to the surgical approach itself is the anterior approach. The advantages of surgery are obvious. Due to the limitations of the quantity and methodological quality of the study, large samples and high quality randomized controlled studies are needed to draw more credible conclusions.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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