CAJ | 학술논문

背景：目前有关颈椎后路单开门椎管扩大成形中微型钛板固定与丝线悬吊固定比较的文献较多，但大多研究的样本量存在局限，对于微型钛板应用的优缺点缺乏客观评价。 　　目的：系统评价颈椎后路单开门椎管扩大成形中微型钛板固定与传统丝线悬吊固定对颈椎疾患的修复效果和安全性。 　　方法：由2名评价员检索中/英文公开发表的随机对照试验。计算机检索the Cochrane Central Register of Controled Trials(CENTRAL)、PubMed、EMbase、the ISI Web of Knowledge Database、CNKI、CMB、VIP、万方数据库公开发表的有关颈椎后路单开门椎管扩大成形中微型钛板固定与传统丝线悬吊固定的随机对照试验。检索时间均为建库时间至2015年3月1日。同时，手检纳入文献的参考文献。Meta分析采用Cochrane协作网提供的Rev-Man 5.3软件进行。 　　结果与结论：共纳入9个研究，642例患者。Meta分析结果显示：①在安全性方面：两组手术时间[SMD=-0.02，95%CI(-0.57，0.54)，P=0.95>0.05]、术中出血量[SMD=0.07，95%CI(-0.26，0.40)，P=0.69>0.05]差异无显著性意义。②在有效性方面：与传统丝线悬吊固定相比，微型钛板固定术后JOA评分较高[SMD=0.26，95%CI(0.10，0.42)，P=0.001<0.05]、椎板开门角度较大[SMD=0.25，95%CI(0.02，0.48)，P=0.04<0.05]、颈椎曲度维持较好[SMD=0.46，95%CI(0.27，0.65)，P<0.00001]、轴性症状发生率较低[RR=0.40，95%CI(0.29，0.56)，P<0.00001]。提示临床上采用单开门椎板扩大成形修复颈椎病时，使用微型钛板固定与丝线悬吊固定均能取得较好的临床效果，但微型钛板固定组在JOA评分、椎板开门角度方面优于丝线悬吊固定组，并能有效的防止颈椎曲度丢失及降低轴性症状的发生率；但因原始研究质量不高，样本不大，建议临床上谨慎使用，尚需要更多高质量大样本的随机对照试验进一步论证。揹景：目前有關頸椎後路單開門椎管擴大成形中微型鈦闆固定與絲線懸弔固定比較的文獻較多，但大多研究的樣本量存在跼限，對于微型鈦闆應用的優缺點缺乏客觀評價。 　　目的：繫統評價頸椎後路單開門椎管擴大成形中微型鈦闆固定與傳統絲線懸弔固定對頸椎疾患的脩複效果和安全性。 　　方法：由2名評價員檢索中/英文公開髮錶的隨機對照試驗。計算機檢索the Cochrane Central Register of Controled Trials(CENTRAL)、PubMed、EMbase、the ISI Web of Knowledge Database、CNKI、CMB、VIP、萬方數據庫公開髮錶的有關頸椎後路單開門椎管擴大成形中微型鈦闆固定與傳統絲線懸弔固定的隨機對照試驗。檢索時間均為建庫時間至2015年3月1日。同時，手檢納入文獻的參攷文獻。Meta分析採用Cochrane協作網提供的Rev-Man 5.3軟件進行。 　　結果與結論：共納入9箇研究，642例患者。Meta分析結果顯示：①在安全性方麵：兩組手術時間[SMD=-0.02，95%CI(-0.57，0.54)，P=0.95>0.05]、術中齣血量[SMD=0.07，95%CI(-0.26，0.40)，P=0.69>0.05]差異無顯著性意義。②在有效性方麵：與傳統絲線懸弔固定相比，微型鈦闆固定術後JOA評分較高[SMD=0.26，95%CI(0.10，0.42)，P=0.001<0.05]、椎闆開門角度較大[SMD=0.25，95%CI(0.02，0.48)，P=0.04<0.05]、頸椎麯度維持較好[SMD=0.46，95%CI(0.27，0.65)，P<0.00001]、軸性癥狀髮生率較低[RR=0.40，95%CI(0.29，0.56)，P<0.00001]。提示臨床上採用單開門椎闆擴大成形脩複頸椎病時，使用微型鈦闆固定與絲線懸弔固定均能取得較好的臨床效果，但微型鈦闆固定組在JOA評分、椎闆開門角度方麵優于絲線懸弔固定組，併能有效的防止頸椎麯度丟失及降低軸性癥狀的髮生率；但因原始研究質量不高，樣本不大，建議臨床上謹慎使用，尚需要更多高質量大樣本的隨機對照試驗進一步論證。
배경：목전유관경추후로단개문추관확대성형중미형태판고정여사선현조고정비교적문헌교다，단대다연구적양본량존재국한，대우미형태판응용적우결점결핍객관평개。 　　목적：계통평개경추후로단개문추관확대성형중미형태판고정여전통사선현조고정대경추질환적수복효과화안전성。 　　방법：유2명평개원검색중/영문공개발표적수궤대조시험。계산궤검색the Cochrane Central Register of Controled Trials(CENTRAL)、PubMed、EMbase、the ISI Web of Knowledge Database、CNKI、CMB、VIP、만방수거고공개발표적유관경추후로단개문추관확대성형중미형태판고정여전통사선현조고정적수궤대조시험。검색시간균위건고시간지2015년3월1일。동시，수검납입문헌적삼고문헌。Meta분석채용Cochrane협작망제공적Rev-Man 5.3연건진행。 　　결과여결론：공납입9개연구，642례환자。Meta분석결과현시：①재안전성방면：량조수술시간[SMD=-0.02，95%CI(-0.57，0.54)，P=0.95>0.05]、술중출혈량[SMD=0.07，95%CI(-0.26，0.40)，P=0.69>0.05]차이무현저성의의。②재유효성방면：여전통사선현조고정상비，미형태판고정술후JOA평분교고[SMD=0.26，95%CI(0.10，0.42)，P=0.001<0.05]、추판개문각도교대[SMD=0.25，95%CI(0.02，0.48)，P=0.04<0.05]、경추곡도유지교호[SMD=0.46，95%CI(0.27，0.65)，P<0.00001]、축성증상발생솔교저[RR=0.40，95%CI(0.29，0.56)，P<0.00001]。제시림상상채용단개문추판확대성형수복경추병시，사용미형태판고정여사선현조고정균능취득교호적림상효과，단미형태판고정조재JOA평분、추판개문각도방면우우사선현조고정조，병능유효적방지경추곡도주실급강저축성증상적발생솔；단인원시연구질량불고，양본불대，건의림상상근신사용，상수요경다고질량대양본적수궤대조시험진일보론증。
BACKGROUND:Many studies concern the comparison of micro-titanium plate fixation and suture suspension fixation during cervical posterior expansive open-door laminoplasty, but the sample size of many studies has limitations. There is lack of objective evaluation on advantages and disadvantages of micro-titanium plate. OBJECTIVE:To systemicaly evaluate the efficacy and safety of micro-titanium plate fixationversus suture suspension fixation in cervical posterior expansive open-door laminoplasty. METHODS: English and Chinese randomized controled trials were searched by two reviewers. They retrieved the Cochrane Central Register of Controled Trials (CENTRAL), PubMed, EMbase, the ISI Web of Knowledge Database, CNKI, CMB, VIP and Wanfang database for randomized controled trials addressing micro-titanium plate fixationversus suture suspension fixation in cervical posterior expansive open-door laminoplasty published from database foundation to March 1, 2015. The references were also searched by hand. Meta-analyses were performed by using the Rev-Man 5.3 software, provided by the Cochrane Colaboration. RESULTS AND CONCLUSION: A total of 9 studies involving 642 patients were included. The results of meta-analyses showed that: (1) safety: There were no significant differences between the two groups in operation time [SMD=-0.02, 95%CI (-0.57, 0.54),P=0.95 > 0.05], and intraoperative blood loss [SMD=0.07, 95%CI (-0.26, 0.40),P=0.69 > 0.05]. (2) Efficacy: compared with suture suspension fixation, Japanese Orthopaedic Association Scores were higher [SMD=0.26, 95%CI (0.10, 0.42),P=0.001 < 0.05], the angle of the opened laminae was bigger [SMD=0.25, 95%CI (0.02, 0.48),P=0.04 < 0.05], cervical curvature was better [SMD=0.46, 95%CI (0.27, 0.65),P < 0.000 01], and incidence of axial symptoms was lower [RR=0.40, 95%CI(0.29, 0.56),P< 0.000 01] after micro-titanium plate fixation. These findings suggest that during expansive open-door laminoplasty for treatment of cervical spondylosis, micro-titanium plate fixation and suture suspension fixation can obtain good clinical outcomes. However, Japanese Orthopaedic Association Scores were higher and the angle of the opened laminae was better in micro-titanium plate fixation than in suture suspension fixation. Micro-titanium plate fixation could effectively prevent loss of cervical curvature and reduce the incidence of axial symptoms. For the poor quality of the original studies and smal sample size, a prudent choice is suggested. More high-quality large-sample studies are needed for further verification.