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不同手术入路治疗下颈椎小关节脱位疗效的系统评价及Meta分析

江晨1 宋文慧1,2

太原,山西医科大学第二临床医学院1;030001 太原,山西医科大学第二医院骨科2

宋文慧,Email: songwenhui301@sina.com

摘 要:目的 应用系统评价及Meta分析的方法评价不同手术入路治疗下颈椎小关节脱位的疗效。方法 计算机检索PubMed(1966年至2016年6月)、EMbase(1974年至2016年6月)、Cochrane图书馆(2016年第6期)、中国生物医学文献数据库(CBM,1978年至2016年6月)、中国期刊全文数据库(CNKI,1994年至2016年6月)及万方数据库(1998年至2016年6月),手工检索相关的中英文骨科杂志和会议论文,收集不同手术入路治疗下颈椎小关节脱位的随机或非随机对照研究,由两名评价员按纳入与排除标准选择文献、提取资料和质量评价后,采用ReMan 5.2软件对可以合并分析的指标进行Meta分析,对不能合并的指标采用描述性分析。结果 共纳入7篇文献,652例患者,其中前路手术患者290例,后路手术患者151例,前后联合入路患者211例。分析结果显示:前路的手术时间小于后路(WMD=-22.22,95% CI:-34.20~-10.24,P=0.000 3)及前后联合入路(WMD=-117.27,95% CI:-132.41~-102.12,P<0.000 01);前路的出血量小于后路(WMD=-255.33,95% CI:-306.81~-203.85,P<0.000 01)及前后联合入路(WMD=-402.84,95% CI:-489.59~-316.09,P<0.000 01);前路与前后联合入路的固定节段无统计学差异(WMD=-1.38,95% CI:-4.18~1.43,P=0.34),但均小于后路(WMD=-1.29,95% CI:-2.16~-0.42,P=0.004);前路的术后椎体水平位移小于后路(WMD=-0.06,95% CI:-0.10~-0.03,P=0.000 4)及前后联合入路(WMD=-1.67,95% CI:-2.60~-0.74,P=0.000 4);前路与后路的术后Cobb角无统计学差异(WMD=-0.18,95% CI:-0.61~0.26,P=0.42),但小于前后联合入路(WMD=-1.29,95% CI:-2.25~-0.33,P=0.008)。结论 虽然不同手术入路均有较好的临床疗效,但就手术入路本身而言,前路手术的优势较明显。限于纳入研究数量及方法学质量的局限性,研究结果尚需要大样本、高质量的随机对照研究进一步证实。

关键词:下颈椎; 小关节脱位; 手术入路; 系统评价; Meta分析

A systematic review and Meta-analysis of the clinical efficacy of facet dislocation of lower cervical spine

Jiang Chen1, Song Wenhui1,2.

Shanxi Medical University Second Clinical College, Taiyuan 030000, China; 2Department of Orthopaedics, the Second Hospital, Shanxi Medical University, Taiyuan 030001, China

Song Wenhui, Email: songwenhui301@sina.com

Abstract:Objective To conduct a systematic review and Meta-analysis of the efficiency of various approaches for facet dislocation of lower cervical spine. Methods A computerized search was conducted on electronic database of PubMed (from 1966 to June 2016), Embase (from 1974 to June 2016), Cochrane Library (Issue 6 2016), CBM (from 1978 to June 2016), CNKI (from 1994 to June 2016), WanFang database (from 1998 to June 2016), some relevant journals were hand searched as well to collect the randomized controlled trials or non-randomized controlled trials about various approaches in the treatment of lower cervical spine facet dislocation. Two reviewers independently screened the literature according to the inclusive and exclusive criteria, extracted the data, and assessed the methodological quality of included studies. Meta analysis was conducted using RevMan 5.2 software, and the studies that could not be combined were analyzed descriptively. Results A total of 7 literatures involving 652 patients were included. There were 290 patients in anterior approach, 151 patients in posterior approach and 211 patients in combined anterior and posterior approach. Analysis results showed that, the operation time of anterior approach was less than posterior approach (WMD=-22.22, 95% CI: -34.20--10.24, P=0.000 3) and combined approach (WMD=-117.27, 95% CI: -132.41--102.12, P<0.000 01); the amount of bleeding of anterior approach was less than posterior approach (WMD=-255.33, 95% CI: -306.81--203.85, P<0.000 01) and combined approach (WMD=-402.84, 95% CI: -489.59--316.09, P<0.000 01); there was no statistical difference in the fusion levels of anterior approach and combined approach (WMD=-1.38, 95% CI: -4.18-1.43, P=0.34), but were all shorter than posterior approach (WMD=-1.29, 95% CI: -2.16--0.42, P=0.004); the postoperative vertebral horizontal displacement of anterior approach was less than posterior approach (WMD=-0.06, 95% CI: -0.10--0.03, P=0.000 4) and combined approach (WMD=-1.67, 95% CI: -2.60--0.74, P=0.000 4); and there was no statistical difference in the postoperative Cobb angle of anterior approach and posterior approach (WMD=-0.18, 95% CI: -0.61-0.26, P=0.42), but was smaller than combined approach (WMD=-1.29, 95% CI: -2.25--0.33, P=0.008). Conclusions Although all the approaches in treating lower cervical spine facet dislocation can achieve better clinical efficacy, but as for the surgical approach itself, the anterior approach is superior to others. For the limitations of quantity and methodological quality of included studies, this conclusion still needs to be further proved by performing more large-scale and high-quality randomized controlled trails.

Key words:Lower cervical spine; Facet dislocation; Surgical approach; Systematic review; Meta-analysis

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文献标引:江晨1 宋文慧1,2.不同手术入路治疗下颈椎小关节脱位疗效的系统评价及Meta分析[J/CD].中华临床医师杂志:电子版,2017,11(4):622.

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