比较4种方案治疗脊髓型颈椎病效果的系统性评价

背景：对于多节段脊髓型颈椎病,手术治疗方式的选择尚存争议.目的：对脊髓型颈椎病的4种治疗方式进行系统评价.方法：选取1980/2010-12有关比较多节段椎体次全切除＋融合、前路颈椎间盘切除＋融合、椎管扩大成形及椎板切除减压＋融合文章的回顾性分析,系统评价脊髓型颈椎病治疗的最佳治疗方式,并对随访超过10年的病例进行独立评价.结果与结论：共检索到1 718篇文章,筛选出591篇摘要,36篇有全文,均为回顾性队列研究.有4项研究比较了多节段椎体次全切除＋融合和椎管扩大成形,1项研究比较了椎板切除减压＋融合和椎管扩大成形,2项研究比较了前路颈椎间盘切除＋融合和椎管扩大成形.3项病例研究随访时间在10年以上.所有治疗方法的神经功能改善率基本相同.与多节段椎体次全切除＋融合相比,椎管扩大成形有较高的颈痛发生率.与椎管扩大成形相比,前路颈椎间盘切除＋融合增加了邻近节段继发性病变的概率.多节段椎体次全切除＋融合和椎板切除减压＋融合有较高的与植骨、内固定、手术入路相关的并发症.与椎板切除减压＋融合相比,多节段椎体次全切除＋融合和椎板切除减压＋融合后颈活动范围明显下降.

Systematic review the effects of four operative techniques in treating cervical spondylotic myelopathy

BACKGROUND：There is still a controversy about the surgery in treating multilevel cervical spondylotic myelopathy（CSM）.OBJECTIVE：To review 4 operative techniques which were used for the CSM treatment.METHODS：From 1980 to December 2010,a systematic review of retrospective cohort studies with multilevel anterior multilevel corpectomyand fusion（AMCF）,anterior cervical discectomy and fusion（ACDF）,expensive laminoplasty（EXLP） and decompressive laminectomy and fusion（DLEF） was performed to systematic evaluate the optimum treatment for CSM with over 10-year follow-up.RESULTS AND CONCLUSION：A total of 1 718 articles were retrieved,finally 591 abstracts,36 articles in full were included.Retrospective cohort studies were compared in all studies.Four studies compared AMCF＋EXLP,one study compared DLEF＋EXLP,and two studies compared ACDF＋EXLP.There were 3 case studies with over 10 years follow-up.neurological recovery rates in all approaches showed no difference.EXLP had a significant incidence of neck pain as compared with multilevel AMCF.The rate of adjacent secondary spondylosis in ACDF was increased as compared with EXLP.AMCF＋DLEF had a significantly higher rate of graft,instrumentation,and approach related complications.AMCF＋DLEF had a significant decrease in range of motion of neck as compared with EXLP.