颈椎前路椎体次全切除术和后路椎板成形术治疗后纵韧带钙化疗效的Meta分析

目的:系统评价颈椎前路椎体次全切除术(anterior cervical corpectomy and fusion,ACCF)和后路椎板成形术(laminoplasty,LAMP)治疗后纵韧带钙化(ossification of posterior longitudinal ligament,OPLL)疗效。方法:通过计算机检索1970年至2018年5月PubMed、EMBASE、Cochrane Library、CBM、中国知网、万方、维普7个数据库中的ACCF和LAMP治疗颈椎OPLL相关文献。按照标准纳入文章,并由2位作者进行独立筛选。运用MINORS评分量表(methodological index for non randomized studies)对文章进行质量评分。提取文章中的数据后,应用Review Manager 5.3软件分别对JOA评分、颈椎曲度、手术时间、出血量、优良率、恢复率、不良事件和二次手术进行分析。结果:最后此次Meta分析共纳入22篇相关研究,1 678例患者,其中ACCF组810例,LAMP组868例。Meta分析结果显示,ACCF组术后JOA评分MD=0.63,95%CI(0.05,1.20),P=0.03],优良率OR=1.85,95%CI(1.14,3.02),P=0.01]和恢复率OR=11.90,95%CI(5.75,18.05),P=0.000 1]更优,但LAMP组手术时间短MD=52.19,95%CI (29.36,75.03),P0.000 01],不良事件少OR=1.56,95%CI(1.03,2.35),P=0.04]和二次手术OR=3.73,95%CI (1.62,8.57),P=0.002]少,而两组颈椎曲度OR=3.15,95%CI(-0.14,6.43),P=0.06]和出血量SMD=0.26,95%CI(-0.05,0.57),P=0.10]比较差异无统计学意义。结论 :ACCF术后颈椎神经功能恢复更优,但LAMP手术时间、不良事件和二次手术均低于ACCF,两组颈椎曲度恢复和术中出血量无差异。但本研究存在一定局限性,因此,尚需更高质量和更大样本量的临床研究来进一步验证。

Meta-analysis of calcium chemotherapeutic effect of anterior cervical subtotal vertebroplasty and posterior laminoplasty

Objective: To systematically assess the efficacy of anterior cervical corpectomy and fusion (ACCF) versus posterior laminoplasty (LAMP) for cervical ossification of posterior longitudinal ligament (OPLL).Methods: PubMed and EMBASE,Cochrane Library,CBM,CNKI,Wanfang and VIP were collected from 7 databases of ACCF,LAMP from 1970 to May 2018. According to the criteria,the articles were included and independently screened by two authors. The quality of the articles was assessed by using the MINORS scale(methodological index for non-randomized studies). After extracting the data from the article,the JOA score,cervical curvature,operation time,bleeding volume,excellent and good rate,recovery rate,adverse events and secondary surgery were analyzed by using Review Manager 5.3 software.Results: Finally,a total of 22 articles with 1 678 patients were included in this Meta-analysis,with 810 patients in ACCF group and 868 patients in LAMP group. Meta-analysis results showed that the ACCF group had higher postoperative JOA scoresMD=0.63,95%CI(0.05,1.20),P=0.03],higher excellent rateOR=1.85,95%CI(1.14,3.02),P=0.01] and higher recovery rateOR=11.90,95%CI(5.75, 18.05),P=0.000 1]. But the LAMP group has a shorter operative timeMD=52.19,95%CI(29.36,75.03),P<0.000 01],less complicationsOR=1.56,95%CI(1.03,2.35),P=0.04] and less reoperationsOR=3.73,95%CI(1.62,8.57),P=0.002]. There was no significant different in postoperative lordosisMD=3.15,95%CI(-0.14,6.43),P=0.06] and blood lossSMD=0.26,95%CI(-0.05,0.57),P=0.10] between two groups.Conclusion: The recovery of function of ACCF group was better,but operation time,complications and reoperations of LAMP group were all better than ACCF group. There was no difference in postoperative lordosis and intraoperative blood loss between two groups. However,there are some limitations in this study. Therefore,higher quality and larger sample size clinical studies are needed to further verify.