在颈椎椎板成形术中，微型钢板固定是否优于缝线悬吊固定？一项Meta分析。

Is Mini-Plate Fixation Superior to Suture Suspensory Fixation in Cervical Laminoplasty? A Meta-Analysis.

作者信息

Qi Qihua, Li Liangping, Luo Jiaquan, Huang Sheng, Zhou Zhiyu, Gao Manman, Zou Xuenong

机构信息

Department of Spine Surgery, Orthopedic Research Institute, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.

出版信息

World Neurosurg. 2016 Sep;93:144-53. doi: 10.1016/j.wneu.2016.06.011. Epub 2016 Jun 11.

DOI:10.1016/j.wneu.2016.06.011

PMID:27302561

Abstract

BACKGROUND

Owing to the small sample sizes in individual studies reported to date, whether or not mini-plate fixation is better than suture suspensory fixation in unilateral open-door laminoplasty is unclear. Thus, we conducted a meta-analysis to evaluate which fixation method is superior in cervical laminoplasty for patients with multilevel cervical spondylotic myelopathy (MCSM).

METHODS

Several electronic databases were selected to search the related studies. The main endpoints included operation time, blood loss, preoperative Japanese Orthopedic Association (JOA) score, postoperative JOA score, JOA recovery rate, postoperative anteroposterior diameter, open angle, and the incidence of axial symptoms or C5 palsy after surgery. The results are presented as mean difference (MD) for continuous outcomes and odds ratio (OR) with 95% confidence interval (CI) for dichotomous outcomes.

RESULTS

Six studies, including a total of 436 patients, were included in this review. The postoperative JOA score was higher in patients receiving suture suspensory fixation (group B) than in those receiving mini-plate fixation (group A) (MD, 0.51; 95% CI, 0.07-0.96; P = 0.002), as was the incidence of C5 palsy (OR, 0.37; 95% CI, 0.15-0.92; P = 0.03). In 5 of the 6 studies, including 282 patients, the incidence of axial symptoms was lower in group A (OR, 0.37; 95% CI, 0.21-0.67; P = 0.0009). There were no significant differences (P > 0.05) between groups A and B in terms of operation time, blood loss, JOA recovery rate, postoperative anteroposterior diameter, or open angle after surgery.

CONCLUSIONS

Although suture suspensory fixation was associated with better postoperative JOA scores, mini-plate fixation was superior in reducing the incidence of surgical complications. To avoid severe surgical complications, mini-plate fixation is a good choice for laminoplasty for patients with MCSM. Valid evidence depends on more high-quality, randomized controlled trials in the future.

摘要

背景

由于迄今为止报道的个别研究样本量较小，在单侧开门式椎板成形术中微型钢板固定是否优于缝线悬吊固定尚不清楚。因此，我们进行了一项荟萃分析，以评估在多节段脊髓型颈椎病（MCSM）患者的颈椎椎板成形术中哪种固定方法更具优势。

方法

选择多个电子数据库检索相关研究。主要终点包括手术时间、失血量、术前日本骨科协会（JOA）评分、术后JOA评分、JOA恢复率、术后矢状径、开门角度以及术后轴性症状或C5麻痹的发生率。连续变量结果以均值差（MD）表示，二分变量结果以比值比（OR）及95%置信区间（CI）表示。

结果

本综述纳入了6项研究，共436例患者。接受缝线悬吊固定（B组）的患者术后JOA评分高于接受微型钢板固定（A组）的患者（MD，0.51；95%CI，0.07 - 0.96；P = 0.002），C5麻痹的发生率也是如此（OR，0.37；95%CI，0.15 - 0.92；P = 0.03）。在6项研究中的5项（共282例患者）中，A组的轴性症状发生率较低（OR，0.37；95%CI，0.21 - 0.67；P = 0.0009）。A组和B组在手术时间、失血量、JOA恢复率、术后矢状径或术后开门角度方面无显著差异（P > 0.05）。