You Jing-Yang, Zheng Yong, Chen Ming, Fan Jiang-Rong
Department of Trauma Orthopaedics, the First Hospital Affiliated to Sciecne and Techenque College of Hubei, Xianning 437100, Hubei, China.
Department of Trauma Orthopaedics, the First Hospital Affiliated to Sciecne and Techenque College of Hubei, Xianning 437100, Hubei, China;
Zhongguo Gu Shang. 2017 Jan 25;30(1):71-78. doi: 10.3969/j.issn.1003-0034.2017.01.017.
To assess the clinical effectiveness and safety of anterior versus posterior approach for multilevel cervical spondylotic myelopathy.
The following databases were searched: the Cochrane Library, PubMed, EM base, OVID, CBM, Wanfang Data, CNKI. Relevant journals were manually searched for randomized controlled trials or clinical controlled trials(CCTs) that investigated the clinical effectiveness and safety of anterior and posterior approach for multilevel cervical spondylotic myelopathy. Two reviewers independently screened the literature according to inclusion and exclusion criteria, extracted the data, and assessed the methodological quality of included studies. Meta-analysis was performed by using RevMan 5.2 software.
Eight CCTs, involving 1 151 patients, were included. Significant differences were found between anterior and posterior approach with respect to complications, OR=2.19, 95%CI (1.50, 3.19), <0. 000 1; and neural recovery rate, WMD=11.04, 95% CI(0.60, 21.47), =0.04 . In addition, there were no significant differences in preoperative JOA scores, WMD=0.13, 95% CI (-0.20, 0.46), =0. 44; postoperative JOA scores, WMD=0.45, 95% CI (-0.10, 1.00), =0.11; operation time, WMD=39.43, 95% CI(-5.92, 84.78), =0.09; and amount of intraoperative bleeding, WMD=5.46, 95% CI(-96.65, 107.58), =0. 92).
There are no significant differences between anterior and posterior approach for multilevel cervical spondylotic myelopathy in the recovery of neural function of the spinal cord, operation time and intraoperative bleeding. However, posterior appreach showed fewer complications than anterior appreach.
评估前路与后路手术治疗多节段脊髓型颈椎病的临床疗效及安全性。
检索以下数据库：Cochrane图书馆、PubMed、EMbase、OVID、中国生物医学文献数据库（CBM）、万方数据、中国知网（CNKI）。手工检索相关期刊，查找比较前路与后路手术治疗多节段脊髓型颈椎病临床疗效及安全性的随机对照试验或临床对照试验（CCT）。两名评价员根据纳入和排除标准独立筛选文献、提取数据，并评估纳入研究的方法学质量。采用RevMan 5.2软件进行Meta分析。
纳入8项CCT，共1151例患者。前路与后路手术在并发症方面差异有统计学意义，OR=2.19，95%CI（1.50，3.19），P<0.0001；神经恢复率差异有统计学意义，WMD=11.04，95%CI（0.60，21.47），P=0.04。此外，术前JOA评分差异无统计学意义，WMD=0.13，95%CI（-0.20, 0.46）, P=0.44；术后JOA评分差异无统计学意义，WMD=0.45，95%CI（-0.10, 1.00）, P=0.11；手术时间差异无统计学意义，WMD=39.4, 95%CI（-5.92, 84.78）, P=0.09；术中出血量差异无统计学意义，WMD=5.46，95%CI（-96.65, 107.58）, P=0.92。
多节段脊髓型颈椎病前路与后路手术在脊髓神经功能恢复、手术时间及术中出血量方面差异无统计学意义。然而，后路手术并发症少于前路手术。
