颈椎间盘置换与融合术后至少四年的再次手术率：前瞻性随机临床试验的荟萃分析。
Minimum four-year subsequent surgery rates of cervical disc replacement versus fusion: A meta-analysis of prospective randomized clinical trials.
作者信息
Wu T K, Liu H, Wang B Y, Meng Y
机构信息
Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Sichuan 610041, China.
Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Sichuan 610041, China.
出版信息
Orthop Traumatol Surg Res. 2017 Feb;103(1):45-51. doi: 10.1016/j.otsr.2016.10.008. Epub 2016 Nov 24.
INSTRUCTION
Anterior cervical discectomy and fusion (ACDF) is a well-accepted surgical management strategy for radiculopathy and/or myelopathy. However, complications sometimes required subsequent surgery at the operated and adjacent levels. Artificial cervical disc replacement (ACDR) has been accepted as the most extensive non-fusion procedure and is designed to preserve motion. However, some specific complications can result in subsequent surgery, thus, attracting the attention of investigators.
HYPOTHESIS
Compared with ACDF, ACDR had a lower subsequent surgery rates at both operated and adjacent levels after a minimum of four-years of follow-up.
MATERIAL AND METHODS
A meta-analysis was performed with articles published prior to February 2016. Only randomized controlled trials that reported a minimum of 4 years of follow-up with regard to the rates of subsequent surgeries after ACDR compared with ACDF were included in this study. Two reviewers independently screened the articles and data following the PRISMA statement.
RESULTS
Our data showed that the pooled overall rate of subsequent surgery at the operated level and adjacent levels was lower in the ACDR group (7.4%) than in the ACDF group (16.8%) (P=0.0006). For subsequent surgery at the operated level, patients who received ACDR had a lower rate of subsequent surgery than patients who received ACDF (P<0.0001). With respect to the adjacent level, ACDR also had fewer subsequent surgeries compared with ACDF (P<0.0001).
CONCLUSION
ACDR had significantly fewer subsequent surgical interventions compared with ACDF, However, a review of the literature showed that there were an insufficient number of studies with respect to subsequent surgery with a minimum of 4 years of follow-up. Hence, longer-term, multicenter studies are needed for better evaluation of the rate of subsequent surgery after ACDR.
LEVEL OF EVIDENCE
Level I, meta-analysis of high-powered prospective randomized trials.
说明
颈椎前路椎间盘切除融合术（ACDF）是治疗神经根病和/或脊髓病的一种广泛认可的手术治疗策略。然而，并发症有时需要在手术节段及相邻节段进行二次手术。人工颈椎间盘置换术（ACDR）已被公认为最广泛的非融合手术，旨在保留活动度。然而，一些特定并发症可能导致二次手术，因此引起了研究人员的关注。
假设
与ACDF相比，ACDR在至少四年的随访后，手术节段及相邻节段的二次手术率更低。
材料与方法
对2016年2月之前发表的文章进行荟萃分析。本研究仅纳入了报告ACDR与ACDF术后至少4年随访的二次手术率的随机对照试验。两名研究者按照PRISMA声明独立筛选文章和数据。
结果
我们的数据显示，ACDR组手术节段及相邻节段二次手术的总体合并率（7.4%）低于ACDF组（16.8%）（P = 0.0006）。对于手术节段的二次手术，接受ACDR的患者二次手术率低于接受ACDF的患者（P < 0.0001）。在相邻节段方面，与ACDF相比，ACDR的二次手术也更少（P < 0.0001）。
结论
与ACDF相比，ACDR的二次手术干预显著更少。然而，文献综述显示，关于至少4年随访的二次手术的研究数量不足。因此，需要进行长期、多中心研究，以更好地评估ACDR术后的二次手术率。
证据级别
I级，对高质量前瞻性随机试验的荟萃分析。
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