前路颈椎间盘切除融合术优于椎体次全切融合术治疗多节段颈椎病性脊髓病吗？系统评价和荟萃分析。

Is anterior cervical discectomy and fusion superior to corpectomy and fusion for treatment of multilevel cervical spondylotic myelopathy? A systemic review and meta-analysis.

机构信息

Department of Spinal Surgery, East Hospital, Tongji University School of Medicine, Shanghai, China.

Department of Medical Oncology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.

出版信息

PLoS One. 2014 Jan 28;9(1):e87191. doi: 10.1371/journal.pone.0087191. eCollection 2014.

OBJECTIVE

Both anterior cervical discectomy with fusion (ACDF) and anterior cervical corpectomy with fusion (ACCF) are used to treat cervical spondylotic myelopathy (CSM), however, there is considerable controversy as to whether ACDF or ACCF is the optimal treatment for this condition. To compare the clinical outcomes, complications, and surgical trauma between ACDF and ACCF for the treatment of CSM, we conducted a meta-analysis.

METHODS

We conducted a comprehensive search in MEDLINE, EMBASE, PubMed, Google Scholar and Cochrane databases, searching for relevant controlled trials up to July 2013 that compared ACDF and ACCF for the treatment of CSM. We performed title and abstract screening and full-text screening independently and in duplicate. A random effects model was used for heterogeneous data; otherwise, a fixed effect model was used to pool data, using mean difference (MD) for continuous outcomes and odds ratio (OR) for dichotomous outcomes.

RESULTS

Of 2157 citations examined, 15 articles representing 1372 participants were eligible. Overall, there were significant differences between the two treatment groups for hospital stay (M = -5.60, 95% CI = -7.09 to -4.11), blood loss (MD = -151.35, 95% CI = -253.22 to -49.48), complications (OR = 0.50, 95% CI = 0.35 to 0.73) and increased lordosis of C2-C7 (MD = 3.70, 95% CI = 0.96 to 6.45) and fusion segments angles (MD = 3.38, 95% CI = 2.54 to 4.22). However, there were no significant differences in the operation time (MD = -9.34, 95% CI = -42.99 to 24.31), JOA (MD = 0.24, 95% CI = -0.10 to 0.57), VAS (MD = -0.06, 95% CI = -0.81 to 0.70), NDI (MD = -1.37, 95% CI = -3.17 to 0.43), Odom criteria (OR = 0.88, 95% CI = 0.60 to 1.30) or fusion rate (OR = 1.17, 95% CI = 0.34 to 4.11).

CONCLUSIONS

Based on this meta-analysis, although complications and increased lordosis are significantly better in the ACDF group, there is no strong evidence to support the routine use of ACDF over ACCF in CSM.

目的

颈椎前路椎间盘切除融合术（ACDF）和颈椎前路椎体次全切除融合术（ACCF）均可用于治疗脊髓型颈椎病（CSM），然而，对于这两种术式哪一种是治疗 CSM 的最佳术式，存在着较大的争议。为了比较 ACDF 和 ACCF 治疗 CSM 的临床疗效、并发症和手术创伤，我们进行了一项荟萃分析。

方法

我们在 MEDLINE、EMBASE、PubMed、Google Scholar 和 Cochrane 数据库中进行了全面检索，检索截至 2013 年 7 月比较 ACDF 和 ACCF 治疗 CSM 的相关对照试验。我们独立地对标题和摘要进行筛选，然后对全文进行筛选。对异质性数据采用随机效应模型进行分析，否则采用固定效应模型对数据进行合并，采用均数差（MD）表示连续变量的结果，采用比值比（OR）表示二分类变量的结果。

结果

在检索到的 2157 条参考文献中，有 15 篇文章（共 1372 例患者）符合纳入标准。总体而言，两组患者在住院时间（MD = -5.60，95%置信区间为-7.09 至-4.11）、出血量（MD = -151.35，95%置信区间为-253.22 至-49.48）、并发症（OR = 0.50，95%置信区间为 0.35 至 0.73）和 C2-C7 颈椎前凸增加（MD = 3.70，95%置信区间为 0.96 至 6.45）及融合节段角度（MD = 3.38，95%置信区间为 2.54 至 4.22）方面存在显著差异。然而，两组患者在手术时间（MD = -9.34，95%置信区间为-42.99 至 24.31）、日本骨科协会评分（MD = 0.24，95%置信区间为-0.10 至 0.57）、视觉模拟评分（MD =-0.06，95%置信区间为-0.81 至 0.70）、纽芬兰纪念大学颈椎病评分（MD =-1.37，95%置信区间为-3.17 至 0.43）、Odom 疗效评定（OR = 0.88，95%置信区间为 0.60 至 1.30）或融合率（OR = 1.17，95%置信区间为 0.34 至 4.11）方面无显著差异。