中华骨科杂志
中華骨科雜誌
중화골과잡지
Chinese Journal of Orthopaedics
2015年
11期
1142-1150
,共9页
姜东杰%顾庆国%王占超%王新伟%袁文
薑東傑%顧慶國%王佔超%王新偉%袁文
강동걸%고경국%왕점초%왕신위%원문
颈椎%全椎间盘置换%脊柱融合术%前瞻性研究%随机对照试验%再手术%Meta分析
頸椎%全椎間盤置換%脊柱融閤術%前瞻性研究%隨機對照試驗%再手術%Meta分析
경추%전추간반치환%척주융합술%전첨성연구%수궤대조시험%재수술%Meta분석
Cervical vertebrae%Total disc replacement%Spinal fusion%Prospective studies%Randomized controlled trial%Reoperation%Meta-analysis
目的 比较颈椎人工椎间盘置换术与前路减压融合固定术治疗单节段颈椎病术后相邻节段和手术节段再手术的发生率.方法 计算机检索Pubmed、Medline、Ovid、Embase、Cochrane Library和中国生物医学文献数据库、万方、维普等数据库,英文检索词为"cervical"、"replacement OR arthroplasty OR prosthesis’,、"fusion OR arthrodesis","reoperation ORsecondary surgical procedure",中文检索词为"颈椎"、"间盘置换"、"融合"、"再手术".由2名评价者严格按照纳入及排除标准进行文献筛选,收集关于颈椎人工椎间盘置换术与前路减压融合固定术再手术发生率的前瞻性随机对照研究.根据Cochrane Reviews Handbook 5.1.0的RCT偏倚风险评价标准对纳入文献的偏倚风险进行独立评价,并采用Review Manager5.2软件进行统计分析相邻节段和手术节段的再手术发生率.结果12篇文献纳入研究,短期(2年)随机对照研究6篇,中远期(4～8.8年)随机对照研究6篇.4篇为低偏倚风险,7篇为中偏倚风险,1篇为高偏倚风险.Meta分析显示,短期随访结果 中两种术式在相邻节段的再手术发生率无明显差异,而中远期随访结果显示非融合组术后相邻节段再手术率低于融合组;非融合组手术节段再手术率均低于融合组.短期随访中两组患者采用Removal翻修方法的例数无差别;中远期随访中融合组患者采用该翻修方法进行翻修的人数多于非融合组.结论 非融合术式能在一定程度上降低相邻节段再手术的发生率,但是在短期(2年)内对降低邻近节段再手术的发生率效果并不明显.减少融合术后假关节形成是降低融合术式手术节段再手术率的有效方法.
目的 比較頸椎人工椎間盤置換術與前路減壓融閤固定術治療單節段頸椎病術後相鄰節段和手術節段再手術的髮生率.方法 計算機檢索Pubmed、Medline、Ovid、Embase、Cochrane Library和中國生物醫學文獻數據庫、萬方、維普等數據庫,英文檢索詞為"cervical"、"replacement OR arthroplasty OR prosthesis’,、"fusion OR arthrodesis","reoperation ORsecondary surgical procedure",中文檢索詞為"頸椎"、"間盤置換"、"融閤"、"再手術".由2名評價者嚴格按照納入及排除標準進行文獻篩選,收集關于頸椎人工椎間盤置換術與前路減壓融閤固定術再手術髮生率的前瞻性隨機對照研究.根據Cochrane Reviews Handbook 5.1.0的RCT偏倚風險評價標準對納入文獻的偏倚風險進行獨立評價,併採用Review Manager5.2軟件進行統計分析相鄰節段和手術節段的再手術髮生率.結果12篇文獻納入研究,短期(2年)隨機對照研究6篇,中遠期(4～8.8年)隨機對照研究6篇.4篇為低偏倚風險,7篇為中偏倚風險,1篇為高偏倚風險.Meta分析顯示,短期隨訪結果 中兩種術式在相鄰節段的再手術髮生率無明顯差異,而中遠期隨訪結果顯示非融閤組術後相鄰節段再手術率低于融閤組;非融閤組手術節段再手術率均低于融閤組.短期隨訪中兩組患者採用Removal翻脩方法的例數無差彆;中遠期隨訪中融閤組患者採用該翻脩方法進行翻脩的人數多于非融閤組.結論 非融閤術式能在一定程度上降低相鄰節段再手術的髮生率,但是在短期(2年)內對降低鄰近節段再手術的髮生率效果併不明顯.減少融閤術後假關節形成是降低融閤術式手術節段再手術率的有效方法.
목적 비교경추인공추간반치환술여전로감압융합고정술치료단절단경추병술후상린절단화수술절단재수술적발생솔.방법 계산궤검색Pubmed、Medline、Ovid、Embase、Cochrane Library화중국생물의학문헌수거고、만방、유보등수거고,영문검색사위"cervical"、"replacement OR arthroplasty OR prosthesis’,、"fusion OR arthrodesis","reoperation ORsecondary surgical procedure",중문검색사위"경추"、"간반치환"、"융합"、"재수술".유2명평개자엄격안조납입급배제표준진행문헌사선,수집관우경추인공추간반치환술여전로감압융합고정술재수술발생솔적전첨성수궤대조연구.근거Cochrane Reviews Handbook 5.1.0적RCT편의풍험평개표준대납입문헌적편의풍험진행독립평개,병채용Review Manager5.2연건진행통계분석상린절단화수술절단적재수술발생솔.결과12편문헌납입연구,단기(2년)수궤대조연구6편,중원기(4～8.8년)수궤대조연구6편.4편위저편의풍험,7편위중편의풍험,1편위고편의풍험.Meta분석현시,단기수방결과 중량충술식재상린절단적재수술발생솔무명현차이,이중원기수방결과현시비융합조술후상린절단재수술솔저우융합조;비융합조수술절단재수술솔균저우융합조.단기수방중량조환자채용Removal번수방법적례수무차별;중원기수방중융합조환자채용해번수방법진행번수적인수다우비융합조.결론 비융합술식능재일정정도상강저상린절단재수술적발생솔,단시재단기(2년)내대강저린근절단재수술적발생솔효과병불명현.감소융합술후가관절형성시강저융합술식수술절단재수술솔적유효방법.
Objective To compare the incidence of secondary surgical procedures after cervical disc arthroplasty vs anterior cervical discectomy with fusion in patients treated for symptomatic single level cervical spondylosis.Methods An online search of Pubmed, Medline, Ovid, Embase, Cochrane Library, CBM database, Wanfang data and VIP database were searched for prospective randomized controlled trial of cervical disc arthroplasty versus anterior cervical discectomy with fusion in incidence of secondary surgical procedures.Data were collected and extracted by two reviewers independently.Risk of bias was assessed using the criteria of Cochrane Reviews Handbook 5.1.0.Review Manager 5.2 software system was used to evaluate the data for Meta analysis.Results A total of 12 trials were included.Six of them were short-term follow up (two years).The 6 other trials were mid-and long-term follow up (mean 5.8 years).There are 4 trials with low risk of bias, 7 trials with moderate risk of bias, and 1 trial with high risk of bias.The results of meta-analysis showed there was no statistical difference in reoperation rate of adjacent level between the two groups at two years follow-up;however, the reoperation rate of non-fusion group was significantly lower in the non-fusion group compared with fusion group at mid-and long-term follow-up.The incidence of secondary surgical procedures at index level was higher in fusion group than in non-fusion group.No statistical difference was found between the two groups in using ‘ removal’ for secondary surgical procedure at two years follow-up;however, the rate of non-fusion group was significantly lower than fusion group at mid-and long-term follow-up.Conclusion Cervical disc arthroplasty was partly superior to anterior cervical discectomy with fusion in avoiding secondary surgical procedures of adjacent levels.However, non-fusion surgery doesn't have any advantages in short time (two years) follow up.Reducing the incidence of pseudarthrosis was an effective way to decrease the incidence of secondary surgery procedures in index level.
