[1]罗金峰,秋曙祎,王志民,等.颈椎后路单开门椎管扩大成形跳跃式与连续性微型钛板固定治疗多节段脊髓型颈椎病的Meta分析[J].中医正骨,2023,35(10):31-36.
　LUO Jinfeng,QIU Shuyi,WANG Zhimin,et al.Mini-titanium plates alternative-level versus all-level fixation in unilateral open-door laminoplasty through cervical posterior approach for treatment of multisegment cervical spondylotic myelopathy:a meta-analysis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2023,35(10):31-36.
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颈椎后路单开门椎管扩大成形跳跃式与连续性微型钛板固定治疗多节段脊髓型颈椎病的Meta分析()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第35卷
期数:
2023年10期
页码:
31-36
栏目:
文献研究
出版日期:
2023-10-20

文章信息/Info

Title:
Mini-titanium plates alternative-level versus all-level fixation in unilateral open-door laminoplasty through cervical posterior approach for treatment of multisegment cervical spondylotic myelopathy:a meta-analysis
作者:
罗金峰1; 秋曙祎1; 王志民1; 王太红2
1.河南中医药大学第一附属医院,河南 郑州 450000; 2.商丘市中医院,河南 商丘 476000
Author(s):
LUO Jinfeng1; QIU Shuyi1; WANG Zhimin1; WANG Taihong2
1.The First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450000,Henan,China 2.Shangqiu Hospital of Traditional Chinese Medicine,Shangqiu 476000,Henan,China
关键词:
椎板成形术;  脊髓型颈椎病;  骨板;  跳跃式固定;  连续性固定;  专题Meta分析
Keywords:
laminoplasty;  cervical spondylotic myelopathy;  bone plates;  alternative-level fixation;  all-level fixation;  meta-analysis as topic
摘要:
目的:系统评价颈椎后路单开门椎管扩大成形跳跃式与连续性微型钛板固定治疗多节段脊髓型颈椎病(cervical spondylotic myelopathy,CSM)的优劣。方法:通过计算机检索中国知网、万方数据库、维普网、中国生物医学文献服务系统、PubMed、Web of Science、Embase、Cochrane Library中有关颈椎后路单开门椎管扩大成形跳跃式与连续性微型钛板固定治疗多节段CSM对比研究的文献,检索时限均为建库至2022年11月10日。跳跃固定组和连续固定组分别采用颈椎后路单开门椎管扩大成形跳跃式与连续性微型钛板固定治疗。由2名研究人员独立筛选文献、提取数据并评价纳入研究的偏倚风险后,采用RevMan5.4软件进行Meta分析。结果:共纳入12项研究,其中非随机干预性研究11项、随机对照试验1项; 共涉及1037例患者,其中跳跃固定组528例、连续固定组509例。Meta分析结果显示,2组患者末次随访时日本骨科学会评分、神经功能改善率、术后颈椎曲度、术后颈椎活动度、C5神经根麻痹和轴性症状发生率、住院时间的组间差异均无统计学意义; 与连续固定组相比,跳跃固定组的手术时间更短[SMD=-0.33,95%CI(-0.57,-0.08)]、术中出血量更少[SMD=-0.29,95%CI(-0.50,-0.09)]、住院费用更低[SMD=-5.42,95%CI(-7.07,-3.78)]。11项研究报告了再关门现象,至末次随访时2组均未发生再关门现象; 其中2项研究比较了跳跃固定组未使用钛板固定节段与连续固定组对应节段末次随访时的椎板开口角度,Meta分析结果显示跳跃固定组对应节段的椎板开口角度小于连续固定组[MD=-2.57,95%CI(-3.34,-1.81),P=0.000]。针对末次随访时日本骨科学会评分的漏斗图基本对称,提示存在发表偏倚的可能性较小。结论:现有的证据表明,颈椎后路单开门椎管扩大成形跳跃式与连续性微型钛板固定治疗多节段CSM的疗效和安全性相当,但跳跃式微型钛板固定的手术时间更短、术中出血更少、住院费用更低。
Abstract:
Objective:To systematically review the superiority and inferiority of mini-titanium plates alternative-level versus all-level fixation in unilateral open-door laminoplasty through cervical posterior approach for treatment of multisegment cervical spondylotic myelopathy(CSM).Methods:All the comparative study articles about mini-titanium plates alternative-level(alternative-level fixation group)versus all-level fixation(all-level fixation group)in unilateral open-door laminoplasty through cervical posterior approach for treatment of multisegment CSM included from database establishing to November 10,2022 were retrieved from China National Knowledge Internet,Wanfang Database,Vip Database,Chinese Biomedical Literature Service System,PubMed,Web of Science,Embase and Cochrane Library through computer.The patients in alternative-level fixation group and all-level fixation group were treated with mini-titanium plates alternative-level and all-level fixation in unilateral open-door laminoplasty through cervical posterior approach respectively.The articles were screened and the information was extracted independently by two researchers according to the inclusion and exclusion criteria.The methodological quality of research in the articles was evaluated respectively independently by the same two researchers,and if any disagreement was found between them,discussion was conducted for making a final decision,and then a Meta-analysis was conducted by using RevMan5.4 software.Results:Twelve articles(1037 patients)were included in the final analysis,including 11 non-randomized intervention study articles,and 1 randomized controlled trial(RCT)article.Five hundred and twenty-eight patients in alternative-level fixation group,and 509 ones in all-level fixation group.The results of Meta-analysis revealed that,at the last follow-up,there was no statistical difference in Japanese Orthopaedic Association(JOA)score,improvement rate of neurological function,postoperative cervical curvature,postoperative cervical range of motion,incidence rate of C5 nerve root palsy and axial symptoms and hospital stays between the 2 groups; while the operative time was shorter,the intraoperative blood loss and total hospitalization cost were less in alternative-level fixation group compared to all-level fixation group(SMD=-0.33,95%CI(-0.57,-0.08); SMD=-0.29,95%CI(-0.50,-0.09); SMD=-5.42,95%CI(-7.07,-3.78).The reclose of the opened laminae was reported in 11 studies,and no reclose occurred in the 2 groups at the last follow-up.The opening angle of the laminae measured at the last follow-up was compared between the segments fixed with titanium plates in all-level fixation group and the corresponding segments unfixed with titanium plates in alternative-level fixation group in 2 studies,and the results of Meta-analysis revealed that the opening angle was smaller in alternative-level fixation group compared with that of all-level fixation group(MD=-2.57,95%CI(-3.34,-1.81),P=0.000).Publication bias was analyzed according to funnel plots drawned based on JOA score measured at the last follow-up,and the essentially symmetrical funnel plots suggested that publication bias was a remote possibility.Conclusion:Available evidences suggest that mini-titanium plates alternative-level fixation in unilateral open-door laminoplasty through cervical posterior approach is similar to mini-titanium plates all-level fixation in unilateral open-door laminoplasty through cervical posterior approach in clinical outcomes and safety in treatment of multisegment CSM,while the former displays the advantages of shorter operative time,less intraoperative blood loss and total hospitalization cost compared to the latter.

参考文献/References:

[1] 中国中西医结合学会骨伤科分会.脊髓型颈椎病中西医结合诊疗专家共识[J].中国骨伤,2022,35(8):790-798.
[2] MCCORMICK J R,SAMA A J,SCHILLER N C,et al.Cervical spondylotic myelopathy:a guide to diagnosis and management[J].J Am Board Fam Med,2020,33(2):303-313.
[3] 章仁杰,申才良,张秀军,等.脊髓型颈椎病患病特征的流行病学调查[J].安徽医科大学学报,2011,46(9):973-976.
[4] 黄长智,林泉,林久灶.颈后路单开门椎管扩大术治疗颈椎管狭窄症的研究现状与进展[J].生物骨科材料与临床研究,2019,16(2):67-71.
[5] 王锋,龙耀武,赵睿,等.两种手术方式治疗脊髓型颈椎病的疗效比较[J].临床骨科杂志,2021,24(4):457-460.
[6] 刘建,何苗.颈后路微创椎管扩大成形术治疗≥3个节段脊髓型颈椎病的临床研究[J].中国现代医学杂志,2021,31(1):81-85.
[7] 中华外科杂志编辑部.颈椎病的手术治疗及围手术期管理专家共识(2018)[J].中华外科杂志,2018,56(12):881-884.
[8] 冯延冰,李春雷,李刚,等.颈椎后路单开门微型钛板固定的有限元分析[J].中国矫形外科杂志,2020,28(19):1792-1795.
[9] 赵健军,赵庆豪,邓尚希,等.颈椎后路单开门椎管扩大椎板成形术后C5神经根麻痹的解剖学研究[J].中国脊柱脊髓杂志,2020,30(7):638-643.
[10] 杨建成,陈维善,钱胜君.跳跃式Centerpiece内固定在老年多节段脊髓型颈椎病中的应用[J].中国老年学杂志,2016,36(23):5934-5935.
[11] 蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005:104.
[12] 曾宪涛,包翠萍,曹世义,等.Meta分析系列之三:随机对照试验的质量评价工具[J].中国循证心血管医学杂志,2012,4(3):183-185.
[13] 曾宪涛,庄丽萍,杨宗国,等.Meta分析系列之七:非随机实验性研究、诊断性试验及动物实验的质量评价工具[J].中国循证心血管医学杂志,2012,4(6):496-499.
[14] WANG Z F,CHEN G D,XUE F,et al.All levels versus alternate levels plate fixation in expansive open door cervical laminoplasty[J].Indian J Orthop,2014,48(6):582-586.
[15] ZHANG Z,WANG L N,SONG Y M,et al.Comparison of long-term clinical and radiographic outcomes between alternative-level and all-level fixation unilateral open-door laminoplasty[J].Spine J,2020,20(11):1761-1769.
[16] 何少奇,汤呈宣,唐小君,等.颈后路单开门椎管扩大成形跳跃式与连续式微型钛板内固定术治疗多节段脊髓型颈椎病的对比研究[J].中医正骨,2019,31(4):8-16.
[17] 唐少龙,黄庆华,曹华敏,等.不同置板密度的单开门椎管成形术治疗多节段脊髓型颈椎病[J].中国骨伤,2016,29(10):916-922.
[18] 季威,张磊,刘滔,等.颈椎后路单开门椎板成形术中微钛板数量对手术疗效的影响[J].中国矫形外科杂志,2018,26(23):2146-2150.
[19] 朱江军,张冬生,沈泉,等.颈椎单开门微型钛板间隔固定治疗脊髓型颈椎病[J].浙江临床医学,2015,17(5):690-691.
[20] 杨泽川,刘朝旭,林阳,等.颈后路单开门椎管扩大成形术全钛板与交替钛板、缝线固定治疗颈椎病的对比研究[J].北京大学学报(医学版),2019,51(1):187-193.
[21] 格日勒,刘鑫,杨鹏,等.应用跳跃式与连续式Arch钛板内固定的颈椎后路单开门椎管扩大成形术对比研究[J].中华医学杂志,2021,101(25):1978-1984.
[22] 王宗刚,王召兴,刘冬冬,等.颈椎后路单开门4枚钛板固定椎管扩大成形术治疗高龄多节段脊髓型颈椎病的效果及其对颈椎生理曲度的影响[J].包头医学院学报,2020,36(6):28-29.
[23] 甄广强.内固定钛板数量对颈椎管扩大形成术治疗多节段脊髓型颈椎病疗效、颈椎曲度及并发症的影响[J].颈腰痛杂志,2022,43(5):717-719.
[24] 罗喻翔,王吉兴,任海龙,等.颈椎后路单开门椎管扩大成形术中应用不同数量钛板内固定的临床疗效分析[J].中国脊柱脊髓杂志,2019,29(3):228-234.
[25] 韩鹏.3节段与5节段微型钛板固定行后路单开门颈椎管扩大成形术的手术情况及疗效比较[J].颈腰痛杂志,2019,40(6):762-765.
[26] 李海涛,孙丽静.微型钛板固定法治疗多节段脊髓型颈椎病的临床效应[J].基因组学与应用生物学,2019,38(7):3213-3218.
[27] 钟远鸣,莫日养,梁梓扬,等.脊髓型颈椎病的手术治疗研究进展[J].中国全科医学,2018,21(8):998-1002.
[28] 卢海霖,邑晓东,李宏,等.Centerpiece微型钛板固定与传统丝线悬吊在颈椎后路单开门椎管扩大成形术中的应用效果比较研究[J].现代生物医学进展,2019,19(16):3080-3084.
[29] 阮文枫,金祺,刘辉,等.钛板与丝线悬吊固定在颈椎后路单开门椎管扩大成形中应用的Meta分析[J].中国组织工程研究,2015,19(39):6390-6396.
[30] 谢申,祝少博.颈椎后路单开门手术中间隔使用颈椎微型钛板固定的疗效评估[J].中国矫形外科杂志,2016,24(3):204-207.
[31] YANG H L,CHEN G D,ZHANG H T,et al.Open-door laminoplasty with plate fixation at alternating levels for treatment of multilevel degenerative cervical disease[J].J Spinal Disord Tech,2013,26(1):E13-E18.

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　WANG Yuqiang,WANG Limin,LIU Yilin,et al.A study of clinical and imaging characteristics of cervical spondylotic myelopathy combined with cervical posterior longitudinal ligament degeneration[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2020,32(10):6.
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更新日期/Last Update: 1900-01-01