颈椎前路椎间盘切除融合术中动态颈椎钢板与静态颈椎钢板的比较：一项系统评价
Dynamic cervical plate versus static cervical plate in the anterior cervical discectomy and fusion: a systematic review.
作者信息
Li Haidong, Min Jikang, Zhang Qianghua, Yuan Yongjian, Wang Dan
机构信息
Department of Orthopaedics, The first people's Hospital affiliated to Huzhou Teacher's College, Huzhou, 313000, China.
出版信息
Eur J Orthop Surg Traumatol. 2013 Jul;23 Suppl 1:S41-6. doi: 10.1007/s00590-013-1244-8. Epub 2013 Jun 5.
STUDY DESIGN AND OBJECTIVE
This study performs a systematic review to compare the functional outcomes and complications between the dynamic cervical plate and static cervical plate in patients with the anterior cervical discectomy and fusion (ACDF). The common static cervical plates have been widely used in the ACDF. It can successfully increase the fusion rate and decrease the surgery failure. Recently, the dynamic plate has been identified as another safe and efficient option for the better fusion rate by promoting load sharing across the construct. However, the proposed benefits have been largely theoretical, and there is considerable controversy as to which plate is a better option for reconstruction after ACDF.
METHODS
We searched the Cochrane Library, EMBASE, PubMed, and CBM to identify the clinical studies regarding the comparison of dynamic cervical plate with fixed cervical plate in the ACDF. Reports not available in English were excluded. The quality of the included studies was critically assessed, and the data analysis was performed by the Cochrane Collaboration's RevMan 4.2. We defined statistical significance as a P value <0.05.
RESULTS
Five studies were included in this systematic review. In the final analysis, there were 172 patients in the dynamic cervical plate and 143 in the static cervical group. Four studies compared the clinical and radiographic outcomes between the two plate groups in the one-level or two-level fusion segmentation patients, while one studied the patients with the multiple levels. The similar clinical outcomes between the two cervical plate systems were reported in two studies. However, another study suggested that a better clinical outcome was found in the dynamic plate group for the multiple-level fusion patients, although the similar clinical outcome was found in the one-level fusion patients. The two RCT studies with the same clinical data reported that four patients in the static group developed hardware complications, while there was no implant complication in the dynamic group.
CONCLUSION
The clinical outcome was similar in ACDF for one-level fusion patients, although the hardware failure rate was higher in ACDF with static plates.
研究设计与目的
本研究进行了一项系统评价，以比较颈椎前路椎间盘切除融合术（ACDF）患者中动态颈椎钢板与静态颈椎钢板的功能结局和并发症。常见的静态颈椎钢板已广泛应用于ACDF。它能成功提高融合率并降低手术失败率。近年来，动态钢板已被视为另一种安全有效的选择，通过促进整个结构分担负荷可实现更高的融合率。然而，所宣称的益处大多是理论上的，对于ACDF术后重建选用哪种钢板更好存在相当大的争议。
方法
我们检索了考克兰图书馆、EMBASE、PubMed和中国生物医学文献数据库，以确定关于ACDF中动态颈椎钢板与固定颈椎钢板比较的临床研究。排除非英文报告。对纳入研究的质量进行严格评估，并使用考克兰协作网的RevMan 4.2进行数据分析。我们将统计学显著性定义为P值<0.05。
结果
本系统评价纳入了五项研究。在最终分析中，动态颈椎钢板组有172例患者，静态颈椎钢板组有143例患者。四项研究比较了单节段或双节段融合节段患者中两组钢板的临床和影像学结局，而一项研究了多节段患者。两项研究报告了两种颈椎钢板系统的临床结局相似。然而，另一项研究表明，对于多节段融合患者，动态钢板组的临床结局更好，尽管单节段融合患者的临床结局相似。两项具有相同临床数据的随机对照试验研究报告，静态组有4例患者发生硬件并发症，而动态组无植入物并发症。
结论
单节段融合患者的ACDF临床结局相似，尽管使用静态钢板的ACDF硬件失败率更高。
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