CAJ | 학술논문

背景：相邻近节段病是颈前路减压植骨融合后的一种长期并发症，在近些年逐渐受到重视，其发病原因主要有手术邻近节段活动度增大、椎间隙高度丢失、椎间盘内压过高等多方面因素。在实际临床中，颈椎非融合与融合手术相比，是否能有效降低相邻近节段病的发生率，目前还没有明确定论。 　　目的：系统评价颈椎融合和非融合治疗对相邻近节段退变的影响。 　　方法：检索2000年1月至2013年12月Medline、PubMed、Embase和Cochrane等数据库中关于比较颈椎融合与非融合技术修复颈椎病的随机对照试验研究，对比两种修复方法对相邻近节段病的影响，评价纳入研究的方法学质量。利用RevMan 5.2软件进行Meta分析，结局指标为术后因相邻近节段病行二次手术。 　　结果与结论：经过筛选，5篇随机对照试验研究符合纳入标准，共有1602例患者，所有患者均因颈椎病进行手术治疗，其中颈前路减压植骨融合785例，椎间盘置换817例。1066例患者完成了所有随访，总随访率为66.54%，其中颈前路减压植骨融合患者494例，椎间盘置换患者572例，共有68例因相邻近节段病接受了二次手术，总二次手术率为6.38%(68/1066)，其中椎间盘置换后28例，颈前路减压植骨融合后40例。纳入研究的质量评价等级均较高，5篇文献评价等级均为A级，且异质性较小(I2=14%)。Meta分析结果显示，颈椎非融合术后相邻近节段病的二次手术率低于融合手术，差异有显著性意义(OR=0.58，95%CI：0.35，0.96)。提示颈椎融合术后相邻近节段病的二次手术率高于非融合治疗，融合手术所造成的颈椎生物力学改变对相邻近节段病发生的影响更为显著。
배경：상린근절단병시경전로감압식골융합후적일충장기병발증，재근사년축점수도중시，기발병원인주요유수술린근절단활동도증대、추간극고도주실、추간반내압과고등다방면인소。재실제림상중，경추비융합여융합수술상비，시부능유효강저상린근절단병적발생솔，목전환몰유명학정론。 　　목적：계통평개경추융합화비융합치료대상린근절단퇴변적영향。 　　방법：검색2000년1월지2013년12월Medline、PubMed、Embase화Cochrane등수거고중관우비교경추융합여비융합기술수복경추병적수궤대조시험연구，대비량충수복방법대상린근절단병적영향，평개납입연구적방법학질량。이용RevMan 5.2연건진행Meta분석，결국지표위술후인상린근절단병행이차수술。 　　결과여결론：경과사선，5편수궤대조시험연구부합납입표준，공유1602례환자，소유환자균인경추병진행수술치료，기중경전로감압식골융합785례，추간반치환817례。1066례환자완성료소유수방，총수방솔위66.54%，기중경전로감압식골융합환자494례，추간반치환환자572례，공유68례인상린근절단병접수료이차수술，총이차수술솔위6.38%(68/1066)，기중추간반치환후28례，경전로감압식골융합후40례。납입연구적질량평개등급균교고，5편문헌평개등급균위A급，차이질성교소(I2=14%)。Meta분석결과현시，경추비융합술후상린근절단병적이차수술솔저우융합수술，차이유현저성의의(OR=0.58，95%CI：0.35，0.96)。제시경추융합술후상린근절단병적이차수술솔고우비융합치료，융합수술소조성적경추생물역학개변대상린근절단병발생적영향경위현저。
BACKGROUND:Adjacent segment disease is a long-term complication of anterior cervical decompression and fusion, and has been paid great attention recently. Cause of disease contains increased range of motion in surgery adjacent segment, intervertebral height loss and high intradiscal pressure. In the clinic, compared with fusion surgery, whether cervical non-fusion can effectively decrease the incidence of adjacent segment disease remains poorly understood. OBJECTIVE:To systematicaly assess the effects of cervical fusion and cervical non-fusion on adjacent segment degeneration. METHODS:We retrieved the randomized controled trial concerning cervical fusionversuscervical non-fusion to repair cervical syndrome in the Medline, PubMed, Embase and Cochrane databases from January 2000 to December 2013. This study compared the effects of two repair methods on adjacent segment disease and evaluated methodological quality of the included studies. A meta-analysis was performed using RevMan 5.2 software. Outcome indicators: second surgery was undergone due to postoperative adjacent segment disease. RESULTS AND CONCLUSION: After screening, five randomized controled trials met the inclusion criteria. There were 1 602 patients. Al patients received surgery due to cervical syndrome. 785 cases underwent anterior decompression and fusion, and 817 cases underwent intervertebral disc replacement. 1 066 patients completed al folow-up, with a total folow-up rate of 66.54%. There were 494 patients treated with anterior decompression and fusion and 572 patients with intervertebral disc replacement. A total of 68 patients underwent second surgery due to adjacent segment disease. Total second surgery rate was 6.38% (68/1 066), including 28 cases after intervertebral disc replacement and 40 cases after anterior decompression and fusion. The grade of quality evaluation of the included studies was high, including five studies with grade A. Moreover, heterogeneity was smal (I2 = 14%). Meta-analysis results revealed that the second surgery rate of adjacent segment disease was lower after cervical non-fusion than after cervical fusion, which showed significant differences (odd ratio = 0.58, 95% confidence interval: 0.35, 0.96). These results suggested that the second surgery rate of adjacent segment disease was higher after cervical fusion than after cervical non-fusion. The alterations in cervical biomechanics caused by fusion greatly affected the occurrence of adjacent segment disease.