颈椎间盘置换术与经前路颈椎减压融合术的Meta分析

发布时间：2018-12-20 06:35

【摘要】：背景：尽管经前路颈椎减压融合术被认为是治疗有症状颈椎病的标准手术方法,但是它常常会加速邻椎病的发生。颈椎间盘置换术是一项能维持颈椎运动功能的手术方法,被认为是颈椎减压融合术的替代方法。但是颈椎间盘置换术是否优于颈椎减压融合术还没有明确的结论。方法：我们检索了PubMed、EMBASE、Medline和Cochrane Library中2014年12月12日前关于经前路颈椎减压融合术和颈椎间盘置换术的随机对照研究,并且根据随访时间分为短期组和中期组。结果：19篇随机对照研究合计4516例患者被纳入本研究。相对于术后早期来说,颈椎间盘置换术功能恢复更好(包括颈椎功能障碍指数,颈椎功能障碍改善率,神经功能改善率,颈痛NRS评分,疼痛VAS评分,全面改善率),手术节段活动度更大,并发症和再次手术率更低(P0.05)。但是SF-36评分和邻近节段活动度未见明显差异(P0.05)。术后中期,颈椎间盘置换术在颈椎功能障碍指数,神经功能改善率,疼痛NRS评分和手术节段再次手术率均优于融合术(P0.05),而邻近节段二次手术率未见明显差异(P0.05)。结论：颈椎间盘置换术有更好的功能恢复,更少的并发症和再次手术率。不论是在安全性还是有效性上均优于融合术。但是两者的长期效果还需要更多的长期随访的多中心随机对照研究。
[Abstract]:Background: although anterior cervical decompression and fusion is considered to be the standard procedure for the treatment of symptomatic cervical spondylosis, it often accelerates the onset of adjacent spondylosis. Cervical disc replacement is a method to maintain cervical motor function and is considered to be an alternative to cervical decompression and fusion. But there is no clear conclusion whether cervical disc replacement is superior to cervical decompression and fusion. Methods: we searched the randomized controlled study of anterior cervical decompression and fusion and cervical disc replacement in PubMed,EMBASE,Medline and Cochrane Library before December 12, 2014, and were divided into two groups according to the follow-up time. Results: a total of 4516 patients in 19 randomized controlled trials were included in this study. The recovery of cervical disc replacement function was better than early postoperative (including cervical spine dysfunction index, cervical spine dysfunction improvement rate, neural function improvement rate, cervical pain NRS score, pain VAS score, overall improvement rate). The level of motion was higher, the complications and the rate of reoperation were lower (P0.05). However, there was no significant difference between SF-36 score and adjacent segment activity (P0.05). In the middle stage of operation, cervical intervertebral disc replacement was superior to fusion in cervical dysfunction index, neural function improvement rate, pain NRS score and reoperation rate of surgical segment (P0.05). There was no significant difference in the rate of secondary operation in adjacent segments (P0.05). Conclusion: cervical disc replacement has better functional recovery, fewer complications and reoperation rate. It is superior to fusion in safety and effectiveness. But their long-term effects require more long-term follow-up multicenter randomized controlled trials.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R687.3

【参考文献】