Zhang Jianfeng, Meng Fanxin, Ding Yan, Li Jie, Han Jian, Zhang Xintao, Dong Wei
From the Department of acupuncture and moxibustion, Linyi people hospital, Linyi City, Shandong Province (FM), department of spine surgery, Yantai mountain hospital, Yantai city, Shandong provinceGU (YD), Thyroid breast surgery, Zhongshan university first affiliated hospital, Guangdong province (JL), and Department of Bone Tumor, Yantishan Hospital, Yantai, Shandong Province, PR China (JH).
Medicine (Baltimore). 2016 May;95(21):e3621. doi: 10.1097/MD.0000000000003621.
To investigate the outcomes and reliability of hybrid surgery (HS) versus anterior cervical discectomy and fusion (ACDF) for the treatment of multilevel cervical spondylosis and disc diseases.Hybrid surgery, combining cervical disc arthroplasty (CDA) with fusion, is a novel treatment to multilevel cervical degenerated disc disease in recent years. However, the effect and reliability of HS are still unclear compared with ACDF.To investigate the studies of HS versus ACDF in patients with multilevel cervical disease, electronic databases (Medline, Embase, Pubmed, Cochrane library, and Cochrane Central Register of Controlled Trials) were searched. Studies were included when they compared HS with ACDF and reported at least one of the following outcomes: functionality, neck pain, arm pain, cervical range of motion (ROM), quality of life, and incidence of complications. No language restrictions were used. Two authors independently assessed the methodological quality of included studies and extracted the relevant data.Seven clinical controlled trials were included in this study. Two trials were prospective and the other 5 were retrospective. The results of the meta-analysis indicated that HS achieved better recovery of NDI score (P = 0.038) and similar recovery of VAS score (P = 0.058) compared with ACDF at 2 years follow-up. Moreover, the total cervical ROM (C2-C7) after HS was preserved significantly more than the cervical ROM after ACDF (P = 0.000) at 2 years follow-up. Notably, the compensatory increase of the ROM of superior and inferior adjacent segments was significant in ACDF groups at 2-year follow-up (P < 0.01), compared with HS.The results demonstrate that HS provides equivalent outcomes and functional recovery for cervical disc diseases, and significantly better preservation of cervical ROM compared with ACDF in 2-year follow-up. This suggests the HS is an effective alternative invention for the treatment of multilevel cervical spondylosis to preserve cervical ROM and reduce the risk of adjacent disc degeneration. Nonetheless, more well-designed studies with large groups of patients are required to provide further evidence for the benefit and reliability of HS for the treatment of cervical disk diseases.
探讨混合手术（HS）与颈椎前路椎间盘切除融合术（ACDF）治疗多节段颈椎病和椎间盘疾病的疗效及可靠性。混合手术是近年来将颈椎间盘置换术（CDA）与融合术相结合治疗多节段颈椎退变椎间盘疾病的一种新方法。然而，与ACDF相比，HS的疗效和可靠性仍不明确。为了研究HS与ACDF治疗多节段颈椎病患者的情况，检索了电子数据库（Medline、Embase、Pubmed、Cochrane图书馆和Cochrane对照试验中央注册库）。当研究比较HS与ACDF并报告以下至少一项结果时纳入研究：功能、颈部疼痛、手臂疼痛、颈椎活动范围（ROM）、生活质量和并发症发生率。不设语言限制。两位作者独立评估纳入研究的方法学质量并提取相关数据。本研究纳入了7项临床对照试验。2项试验为前瞻性试验，另外5项为回顾性试验。荟萃分析结果表明，在2年随访时，与ACDF相比，HS的NDI评分恢复更好（P = 0.038），VAS评分恢复相似（P = 0.058）。此外，在2年随访时，HS后的颈椎总活动范围（C2-C7）比ACDF后的颈椎活动范围显著保留更多（P = 0.000）。值得注意的是，与HS相比，ACDF组在2年随访时相邻上下节段活动范围的代偿性增加显著（P < 0.01）。结果表明，在2年随访中，HS为颈椎间盘疾病提供了相当的疗效和功能恢复，与ACDF相比，能显著更好地保留颈椎活动范围。这表明HS是治疗多节段颈椎病以保留颈椎活动范围并降低相邻椎间盘退变风险的一种有效的替代方法。尽管如此，仍需要更多设计良好的大样本患者研究来为HS治疗颈椎间盘疾病的益处和可靠性提供进一步证据。
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