CAJ | 학술논문

背景：大量研究已证实前路手术和后路手术治疗多节段脊髓型颈椎病均有较好疗效，但两种治疗方法孰优孰劣，目前尚无定论。 　　目的：系统评价前路与后路手术治疗多节段脊髓型颈椎病的疗效及安全性。 　　方法：计算机检索Cochrane图书馆(2013年第3期)、PubMed(1966年至2013年3月)、OVID(1950年至2013年3月)、EMbase(1966年至2013年3月)、中国生物医学文献数据库(1978年至2013年3月)、万方数据库(1998年至2013年3月)、中国期刊全文数据库(1999年至2013年3月)，手工检索《中华外科杂志》等5种相关杂志，收集前路与后路手术比较治疗多节段脊髓型颈椎病的随机或非随机对照实验，由两名评价者按纳入与排除标准选择文献、提取资料和质量评价后，采用RevMan5.2软件进行Meta分析。 　　结果与结论：最终纳入11个对照实验，共814例患者。Meta分析结果显示：与后路手术相比，前路手术治疗后JOA评分高(P<0.00001)，神经功能改善率高(P=0.0003)，C5神经根麻痹发生率低(P=0.007)，但手术操作时间长(P <0.00001)，出血量大(P=0.0007)，临近节段退变发生率高(P=0.01)，术后并发症发生率高(P<0.00001)，再手术率较高(P=0.003)。两组颈椎活动度比较差异无显著性意义(P=0.56)。由于纳入研究数量有限且方法学质量不高，研究结果尚需更多高质量的随机对照实验进一步证实。
배경：대량연구이증실전로수술화후로수술치료다절단척수형경추병균유교호료효，단량충치료방법숙우숙렬，목전상무정론。 　　목적：계통평개전로여후로수술치료다절단척수형경추병적료효급안전성。 　　방법：계산궤검색Cochrane도서관(2013년제3기)、PubMed(1966년지2013년3월)、OVID(1950년지2013년3월)、EMbase(1966년지2013년3월)、중국생물의학문헌수거고(1978년지2013년3월)、만방수거고(1998년지2013년3월)、중국기간전문수거고(1999년지2013년3월)，수공검색《중화외과잡지》등5충상관잡지，수집전로여후로수술비교치료다절단척수형경추병적수궤혹비수궤대조실험，유량명평개자안납입여배제표준선택문헌、제취자료화질량평개후，채용RevMan5.2연건진행Meta분석。 　　결과여결론：최종납입11개대조실험，공814례환자。Meta분석결과현시：여후로수술상비，전로수술치료후JOA평분고(P<0.00001)，신경공능개선솔고(P=0.0003)，C5신경근마비발생솔저(P=0.007)，단수술조작시간장(P <0.00001)，출혈량대(P=0.0007)，림근절단퇴변발생솔고(P=0.01)，술후병발증발생솔고(P<0.00001)，재수술솔교고(P=0.003)。량조경추활동도비교차이무현저성의의(P=0.56)。유우납입연구수량유한차방법학질량불고，연구결과상수경다고질량적수궤대조실험진일보증실。
BACKGROUND:A large number of studies have confirmed that anterior approach and posterior approach for multilevel cervical spondylotic myelopathy were effective, but there is stil no conclusion in which one is better. OBJECTIVE:To systematical y assess the clinical effectiveness and safety of anterior approach versus posterior approach for multilevel cervical spondylotic myelopathy. METHODS:The databases such as The Cochrane Library (Issue 3, 2013), PubMed (from 1966 to March 2013), OVID (from 1950 to March 2013), EMbase (from 1966 to March 2013), Chinese Biomedical Literature Database (from 1978 to March 2013), WanFang Database (from 1998 to March 2013), China National Knowledge Infrastructure (from 1999 to March 2013) were electronical y searched and five relevant journals were searched by hand to col ect the randomized control ed trials or non-randomized control ed trials about the clinical effectiveness and safety of anterior approach versus posterior approach for multilevel cervical spondylotic myelopathy. Two reviewers independently screened the literature according to the inclusive and exclusive criteria, extracted the data, and assessed the methodological quality of included studies. Then the meta-analysis was performed by using RevMan5.2 software. RESULTS AND CONCLUSION:A total of 11 control ed trials involving 814 patients were included. Meta-analysis results showed that, compared with posterior approach, postoperative Japanese Orthopaedic Association scores were better (P<0.000 01), improvement rate of neurological function was higher (P=0.000 3), the incidence of C5 root palsy was lower (P=0.007), but operation time was longer (P<0.000 01), amount of intraoperative bleedin g was larger (P=0.000 7), incidence of adjacent segments degeneration was higher (P=0.01), incidence of postoperative complications was higher (P<0.000 01) and the rate of secondary surgical procedures was higher (P=0.003) after anterior approach. Additional y, there were no differences between the two groups in the cervical range of motion (P=0.56). For quantity limitation and low methodological quality of included studies, this conclusion stil needs to be further proved by performing more high-quality and large-scale randomized control ed trials.