Anterior controllable antedisplacement and fusion for the treatment of cervical ossification of posterior longitudinal liga-ment:a meta-analysis
王国泰 1冯皓宇 1吴华1
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作者信息
1. 山西医科大学第三医院(山西白求恩医院,山西医学科学院,同济山西医院)骨科,太原 030032
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摘要
目的 分析颈椎前路椎体骨化物复合体前移融合术(anterior controllable antedisplacement and fusion,ACAF)治疗颈椎后纵韧带骨化的有效性和安全性.方法 检索中国知网、万方数据知识服务平台、维普、中华医学期刊全文数据库、PubMed、Embase、Web of Science、Google Scholar中ACAF治疗颈椎后纵韧带骨化的临床研究.提取手术时间、术中出血量、日本骨科协会(Japanese Orthopaedic Association,JOA)评分、颈椎前凸Cobb角、术后并发症发生率等资料,对纳入研究进行meta分析.组间异质性较小时采用固定效应模型进行分析,组间异质性较大时采用随机效应模型进行分析.采用纽卡斯尔-渥太华量表(Newcastle-Ottawa Scale,NOS)对回顾性研究进行文献质量评价.结果 共7篇文献纳入meta分析,共539例患者,其中ACAF组280例、传统减压内固定组259例.Meta分析结果显示ACAF组的手术时间大于传统减压内固定组[WMD=29.60,95％CI(9.60,49.60),P＜0.001],术中出血量小于传统减压内固定组[WMD=-25.80,95％CI(-32.11,-19.48),P＜0.001],颈椎 JOA 评分[WMD=0.82,95％CI(0.35,1.29),P＜0.001]和前凸 Cobb 角[WMD=7.91,95％CI(6.02,9.80),P＜0.001]大于传统减压内固定组.ACAF组术后并发症的发生率低于传统减压内固定组[OR=0.23,95％CI(0.13,0.38),P＜0.001].结论 ACAF治疗颈椎后纵韧带骨化术中出血量低,术后颈椎功能和影像学指标均优于传统减压内固定,且术后并发症发生率更低.
Abstract
Objective To analyze the efficacy and safety of anterior controllable antedisplacement and fusion(ACAF)in the treatment of cervical ossification of posterior longitudinal ligament.Methods Clinical studies on ACAF treatment for ossifica-tion of the posterior longitudinal ligament were searched in CNKI,Wanfang Data Knowledge Service Platform,VIP,Chinese Medi-cal Journal Full-Text Database,PubMed,Embase,Web of Science,and Google Scholar.The operation time,intraoperative blood loss,Japanese Orthopaedic Association(JOA)score,cervical lordosis Cobb angle,and postoperative complications were extracted,and the included studies were analyzed by meta-analysis.The fixed-effects model was used for analysis when heterogeneity be-tween groups was small,and the random-effects model was used when heterogeneity between groups was large.Newcastle-Ottawa Scale(NOS)was used to evaluate the quality of the retrospective studies.Results A total of 7 studies involving 539 patients were included in the meta-analysis,including 280 patients in the ACAF group and 259 patients in the traditional decompression and in-ternal fixation group.The results of meta-analysis showed that the operation time of the ACAF group was longer than that of the tra-ditional decompression and internal fixation group[WMD=29.60,95％CI(9.60,49.60),P＜0.001]and the intraoperative blood loss was less than that of the traditional decompression and internal fixation group[WMD=-25.80,95％CI(-32.11,-19.48),P＜0.001].The cervical JOA score[WMD=0.82,95％CI(0.35,1.29),P＜0.001]and Cobb angle of lordosis[WMD=7.91,95％CI(6.02,9.80),P＜0.001]in the traditional decompression and internal fixation group were higher than those in the traditional decompression and internal fixation group.The incidence of postoperative complications in the ACAF group was lower than that in the traditional de-compression and internal fixation group[OR=0.23,95％CI(0.13,0.38),P＜0.001].Conclusion ACAF for the treatment of cervi-cal posterior longitudinal ligament ossification showed less intraoperative bleeding,better postoperative cervical spine function and imaging indexes than traditional decompression and internal fixation,and a lower postoperative complication rate.
关键词
颈椎/后纵韧带骨化/减压术,外科/Meta分析
Key words
Cervical vertebrae/Ossification of posterior longitudinal ligament/Decompression,surgical/Meta-analysis
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