CAJ | 학술논문

背景：目前以植入物置入稳定脊柱的方法治疗多节段脊髓型颈椎病的主要置入路径为前路入路和后路入路，如何选择存在争议。 　　目的：对于前路与后路入路治疗多节段脊髓型颈椎病的疗效及安全性进行比较。 　　方法：检索 MEDLINE、EMBASE、PubMed 数据库、万方以及中国知网等数据库中有关前路与后路入路方式治疗多节段脊髓型颈椎病的相关研究和文献，对颈椎前路组和颈椎后路组患者置入治疗时间、治疗中出血量、治疗前JOA评分、治疗后JOA评分、并发症发生率、邻近节段退变发生率、颈椎活动度以及再手术率等指标进行比较。 　　结果与结论：12篇研究符合纳入标准，累计病例790例，其中前路组359例，后路组431例。Meta分析表明前路组与后路组治疗前JOA评分、治疗时间、治疗中出血量比较差异无显著性意义(P >0.05)。与后路组相比，前路组治疗后JOA评分高(P<0.001)，临近节段退变发生率高(P=0.02)，颈椎活动范围大(P=0.001)，并发症发生率高(P=0.0002)，再手术率较高(P<0.0001)。结果可见前路与后路治疗脊髓型颈椎病的手术创伤相似，但前路组神经功能改善较好，后路组并发症发生率较低，故临床上应依据实际情况合理选择入路方式。
배경：목전이식입물치입은정척주적방법치료다절단척수형경추병적주요치입로경위전로입로화후로입로，여하선택존재쟁의。 　　목적：대우전로여후로입로치료다절단척수형경추병적료효급안전성진행비교。 　　방법：검색 MEDLINE、EMBASE、PubMed 수거고、만방이급중국지망등수거고중유관전로여후로입로방식치료다절단척수형경추병적상관연구화문헌，대경추전로조화경추후로조환자치입치료시간、치료중출혈량、치료전JOA평분、치료후JOA평분、병발증발생솔、린근절단퇴변발생솔、경추활동도이급재수술솔등지표진행비교。 　　결과여결론：12편연구부합납입표준，루계병례790례，기중전로조359례，후로조431례。Meta분석표명전로조여후로조치료전JOA평분、치료시간、치료중출혈량비교차이무현저성의의(P >0.05)。여후로조상비，전로조치료후JOA평분고(P<0.001)，림근절단퇴변발생솔고(P=0.02)，경추활동범위대(P=0.001)，병발증발생솔고(P=0.0002)，재수술솔교고(P<0.0001)。결과가견전로여후로치료척수형경추병적수술창상상사，단전로조신경공능개선교호，후로조병발증발생솔교저，고림상상응의거실제정황합리선택입로방식。
BACKGROUND:Currently, the treatment of multilevel cervical spondylotic myelopathy mainly contains anterior approach surgery and posterior approach surgery, but how to choose the incision is stil controversial. OBJECTIVE:To compare the therapeutic effect and safety of anterior and posterior approaches for the treatment of multilevel cervical spondylotic myelopathy. METHODS:Databases such as MEDLINE, EMBASE, PubMed, Wanfang data and China National Knowledge Infrastructure were searched about related research and literature on anterior and posterior approaches for the treatment of multilevel cervical spondylotic myelopathy. Operative time, amount of blood loss, preoperative Japanese Orthopedic Association score, postoperative Japanese Orthopedic Association score, complication rate, degeneration rate of adjacent segments, cervical range of motion and reoperation rate were compared between anterior and posterior groups. RESULTS AND CONCLUSION:12 studies were accorded with the inclusion criteria, total y containing 790 cases (359 cases in the anterior group, and 431 cases in the posterior group). Meta-analysis showed that no significant difference in preoperative Japanese Orthopedic Association score, operative time and intraoperative amount of blood loss was detected between the anterior posterior and posterior groups (P>0.05). Compared with the posterior group, Japanese Orthopedic Association scores were higher (P<0.001), degeneration rate of adjacent segments was higher (P=0.02), cervical range of motion was bigger (P=0.001), complication rate was higher (P=0.000 2), and the reoperation rate was higher (P<0.000 1) in the anterior group postoperation. Results showed that surgical invasion between anterior and posterior surgical groups in treatment of cervical myelopathy was similar, but the neurological improvement of anterior group was better, while complication rate of posterior group was lower. Therefore, the choice of surgical approach should be based on clinical practice.