Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Street, Heping District, Tianjin 300052, China.
J Clin Neurosci. 2013 Jul;20(7):970-8. doi: 10.1016/j.jocn.2012.03.046. Epub 2013 Jan 30.
There is no consensus on whether anterior cervical arthroplasty or anterior cervical discectomy and fusion (ACDF) is the optimal treatment for single-level cervical radiculopathy or myelopathy. We conducted a meta-analysis of randomized controlled trials to compare the safety and efficacy of anterior cervical arthroplasty with ACDF. Eight studies met the inclusion criteria. Overall, there were significant differences between these two treatment approaches in the arm visual analog scale (VAS) scores [mean difference (MD)=-4.86, 95% confidence interval (CI)=-6.42 to -3.30], neck VAS scores (MD=-7.90, 95% CI=-10.36 to -5.44), overall success rate [odds ratio (OR)=1.84, 95% CI=1.43 to 2.36], neurological success rate (OR=1.75, 95% CI=1.20 to 2.55), and incidence of reoperation [risk ratio (RR)=0.50, 95% CI=0.26 to 0.97]. However, there were no significant differences in the neck disability index (NDI) scores (MD=-3.81, 95% CI=-8.12 to 0.51), number of adverse events (RR=0.77, 95% CI=0.48 to 1.23), or radiological success rate (OR=0.87, 95% CI=0.36 to 2.09). Based on this meta-analysis, cervical arthroplasty is a safe and effective surgical procedure for treating single-level cervical radiculopathy or myelopathy.
对于单节段颈椎病神经根病或脊髓病，前路颈椎置换术与前路颈椎间盘切除融合术（ACDF）哪种治疗方式更优，目前尚未达成共识。我们对随机对照试验进行了荟萃分析，以比较前路颈椎置换术与 ACDF 的安全性和疗效。符合纳入标准的研究共有 8 项。总体而言，两种治疗方法在手臂视觉模拟量表（VAS）评分[差值（MD）=-4.86，95%置信区间（CI）=-6.42 至-3.30]、颈部 VAS 评分（MD=-7.90，95% CI=-10.36 至-5.44）、总体成功率[比值比（OR）=1.84，95% CI=1.43 至 2.36]、神经功能成功率（OR=1.75，95% CI=1.20 至 2.55）和再次手术发生率[风险比（RR）=0.50，95% CI=0.26 至 0.97]方面存在显著差异。然而，在颈椎功能障碍指数（NDI）评分（MD=-3.81，95% CI=-8.12 至 0.51）、不良事件数量（RR=0.77，95% CI=0.48 至 1.23）或影像学成功率（OR=0.87，95% CI=0.36 至 2.09）方面，两种治疗方法无显著差异。基于这项荟萃分析，颈椎置换术是治疗单节段颈椎病神经根病或脊髓病的一种安全有效的手术方法。
