Cheuk Daniel K L, Wong Virginia, Wraige Elizabeth, Baxter Peter, Cole Ashley
Department of Pediatrics and Adolescent Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong SAR, China.
Cochrane Database Syst Rev. 2015 Oct 1;2015(10):CD005375. doi: 10.1002/14651858.CD005375.pub4.
Scoliosis in patients with Duchenne muscular dystrophy (DMD) is usually progressive and is treated with surgery. However, it is unclear whether the existing evidence is sufficiently scientifically rigorous to support a recommendation for spinal surgery for most patients with DMD and scoliosis. This is an updated review, and an updated search was undertaken in which no new studies were found for inclusion.
To determine the effectiveness and safety of spinal surgery in patients with DMD with scoliosis. We intended to test whether spinal surgery is effective in increasing survival and improving respiratory function, quality of life, and overall functioning, and whether spinal surgery is associated with severe adverse effects.
On 16 June 2015 we searched the Cochrane Neuromuscular Disease Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and CINAHL Plus. We also searched ProQuest Dissertation and Thesis database (January 1980 to June 2015), the National Institutes of Health Clinical Trials Database (6 January 2015), and the WHO International Clinical Trials Registry Platform (17 June 2015), and checked references. We imposed no language restrictions.
We planned to include controlled clinical trials using random or quasi-random allocation of treatment evaluating all forms of spinal surgery for scoliosis in patients with DMD in the review. The control interventions would have been no treatment, non-operative treatment, or a different form of spinal surgery.
We used standard methodological procedures expected by The Cochrane Collaboration. Two review authors independently examined the search results and evaluated the study characteristics against inclusion criteria in order to decide which studies to include in the review.
Of the 49 relevant studies we found, none met the inclusion criteria for the review because they were not clinical trials, but prospective or retrospective reviews of case series.
AUTHORS' CONCLUSIONS: Since no randomized controlled clinical trials were available to evaluate the effectiveness of scoliosis surgery in patients with DMD, we can make no good evidence-based conclusion to guide clinical practice. Patients with scoliosis should be informed as to the uncertainty of benefits and potential risks of surgery for scoliosis. Randomized controlled trials are needed to investigate the effectiveness of scoliosis surgery, in terms of quality of life, functional status, respiratory function, and life expectancy.
杜氏肌营养不良症（DMD）患者的脊柱侧弯通常呈进行性发展，需通过手术治疗。然而，目前尚不清楚现有证据在科学上是否足够严谨，以支持对大多数DMD合并脊柱侧弯患者进行脊柱手术的建议。这是一篇更新的综述，并进行了更新的检索，但未发现新的研究可纳入。
确定脊柱手术治疗DMD合并脊柱侧弯患者的有效性和安全性。我们旨在检验脊柱手术是否能有效提高生存率、改善呼吸功能、生活质量和整体功能，以及脊柱手术是否会带来严重不良反应。
2015年6月16日，我们检索了Cochrane神经肌肉疾病组专业注册库、Cochrane对照试验中心注册库（CENTRAL）、MEDLINE、EMBASE和CINAHL Plus。我们还检索了ProQuest学位论文数据库（1980年1月至2015年6月）、美国国立卫生研究院临床试验数据库（2015年1月6日）和世界卫生组织国际临床试验注册平台（2015年6月17日），并检查了参考文献。我们未设语言限制。
我们计划纳入采用随机或准随机分配治疗的对照临床试验，以评估所有形式的脊柱手术治疗DMD患者脊柱侧弯的效果。对照干预措施应为不治疗、非手术治疗或不同形式的脊柱手术。
我们采用了Cochrane协作网预期的标准方法程序。两位综述作者独立检查检索结果，并根据纳入标准评估研究特征，以决定纳入综述的研究。
我们找到的49项相关研究均未符合综述的纳入标准，因为它们不是临床试验，而是病例系列的前瞻性或回顾性综述。
由于没有随机对照临床试验可用于评估脊柱侧弯手术对DMD患者的有效性，我们无法得出基于充分证据的结论来指导临床实践。应告知脊柱侧弯患者手术益处的不确定性和潜在风险。需要进行随机对照试验来研究脊柱侧弯手术在生活质量、功能状态、呼吸功能和预期寿命方面的有效性。
