颈椎前路椎间盘切除融合术与颈椎前路椎体次全切除融合术治疗脊髓型颈椎病的比较：一项荟萃分析。
Comparison between anterior cervical discectomy with fusion and anterior cervical corpectomy with fusion for the treatment of cervical spondylotic myelopathy: a meta-analysis.
作者信息
Fei Qi, Li Jinjun, Su Nan, Wang Bingqiang, Li Dong, Meng Hai, Wang Qi, Lin Jisheng, Ma Zhao, Yang Yong
机构信息
Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
出版信息
Ther Clin Risk Manag. 2015 Nov 17;11:1707-18. doi: 10.2147/TCRM.S94290. eCollection 2015.
BACKGROUND
Whether anterior cervical discectomy with fusion (ACDF) or anterior cervical corpectomy with fusion (ACCF) is superior in the treatment of cervical spondylotic myelopathy remains controversial. Therefore, we conducted a meta-analysis to quantitatively compare the efficacy and safety of ACDF and ACCF in the treatment of cervical spondylotic myelopathy.
METHODS
PubMed, Embase, Web of Science, SinoMed (Chinese BioMedical Literature Service System, People's Republic of China), and CNKI (China National Knowledge Infrastructure, People's Republic of China) were systematically searched to identify all available studies comparing efficacy and safety between patients receiving ACDF and ACCF. The weighted mean difference (WMD) was pooled to compare the Japanese Orthopaedic Association scores, visual analog scale scores, hospital stay, operation time, and blood loss. The risk ratio was pooled to compare the incidence of complications and fusion rate. Pooled estimates were calculated by using a fixed-effects model or a random-effects model according to the heterogeneity among studies.
RESULTS
Eighteen studies (17 observational studies and one randomized controlled trial) were included in this meta-analysis. Our results suggest that hospital stay (WMD =-1.33, 95% confidence interval [CI]: -2.29, -0.27; P=0.014), operation time (WMD =-26.9, 95% CI: -46.13, -7.67; P=0.006), blood loss (WMD =-119.36, 95% CI: -166.94, -71.77; P=0.000), and incidence of complications (risk ratio =0.51, 95% CI: 0.33, 0.80; P=0.003) in the ACDF group were significantly less than that in the ACCF group. However, other clinical outcomes, including post-Japanese Orthopaedic Association score (WMD =-0.27, 95% CI: -0.57, 0.03; P=0.075), visual analog scale score (WMD =0.03, 95% CI: -1.44, 1.50; P=0.970), and fusion rate (risk ratio =1.04, 95% CI: 0.99, 1.09; P=0.158), between the two groups were not significantly different.
CONCLUSION
Evidence from the meta-analysis of 18 studies demonstrated that surgical options of cervical spondylotic myelopathy using ACDF or ACCF seemed to have similar clinical outcomes. However, ACDF was found to be superior to ACCF in terms of hospital stay, operation time, blood loss, and incidence of complications.
背景
颈椎前路椎间盘切除融合术（ACDF）与颈椎前路椎体次全切除融合术（ACCF）在治疗脊髓型颈椎病方面哪种更具优势仍存在争议。因此，我们进行了一项荟萃分析，以定量比较ACDF和ACCF治疗脊髓型颈椎病的疗效和安全性。
方法
系统检索PubMed、Embase、Web of Science、中国生物医学文献服务系统（SinoMed）和中国知网（CNKI），以识别所有比较接受ACDF和ACCF患者疗效和安全性的现有研究。汇总加权均数差（WMD）以比较日本骨科协会评分、视觉模拟量表评分、住院时间、手术时间和失血量。汇总风险比以比较并发症发生率和融合率。根据研究间的异质性，使用固定效应模型或随机效应模型计算汇总估计值。
结果
本荟萃分析纳入了18项研究（17项观察性研究和1项随机对照试验）。我们的结果表明，ACDF组的住院时间（WMD = -1.33，95%置信区间[CI]：-2.29，-0.27；P = 0.014）、手术时间（WMD = -26.9，95% CI：-46.13，-7.67；P = 0.006）、失血量（WMD = -119.36，95% CI：-166.94，-71.77；P = 0.000）和并发症发生率（风险比 = 0.51，95% CI：0.33，0.80；P = 0.003）均显著低于ACCF组。然而，两组之间的其他临床结局，包括日本骨科协会评分后得分（WMD = -0.27，95% CI：-0.57，0.03；P = 0.075）、视觉模拟量表评分（WMD = 0.03，95% CI：-1.44，1.50；P = 0.970）和融合率（风险比 = 1.04，95% CI：0.99，1.09；P = 0.158），差异均无统计学意义。
结论
18项研究的荟萃分析证据表明，使用ACDF或ACCF治疗脊髓型颈椎病的手术选择似乎具有相似的临床结局。然而，在住院时间、手术时间、失血量和并发症发生率方面，ACDF优于ACCF。
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