单纯椎板切除术治疗黄韧带骨化性胸椎管狭窄症的疗效及并发症：系统评价和荟萃分析。
Outcomes and Complications Following Laminectomy Alone for Thoracic Myelopathy due to Ossified Ligamentum Flavum: A Systematic Review and Meta-Analysis.
机构信息
Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
Faculty of Medicine, University of New South Wales, Sydney, Australia.
出版信息
Spine (Phila Pa 1976). 2018 Jul 15;43(14):E842-E848. doi: 10.1097/BRS.0000000000002563.
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVE
Examine the functional outcomes and complications following laminectomy for thoracic myelopathy due to ossification of the ligamentum flavum (OLF).
SUMMARY OF BACKGROUND DATA
OLF is a rare condition that can cause thoracic myelopathy. Laminectomy is a procedure that can be performed to decompress the spinal cord in patients with thoracic myelopathy due to OLF. Few studies have examined postoperative outcomes and complications following laminectomy for thoracic myelopathy secondary to OLF.
METHODS
A systematic review and meta-analysis was performed. Literature search yielded six studies that met our selection criteria. Study characteristics and baseline patient demographics were extracted from each study. Primary outcomes included pre- and postoperative Japanese Orthopedic Association (JOA) scores and perioperative complications including dural tears, cerebrospinal fluid (CSF) leaks, neurological deficits, surgical site infections, and other complications. We calculated pooled proportion estimates for JOA scores and complications using a random effects model.
RESULTS
A total of 137 patients were included. The pooled pre- and postoperative JOA scores were 5.08 (95% confidence interval [CI], 2.70-7.47; I = 98%) and 8.29 (95% CI, 7.73-8.85; I = 18%), respectively, with a mean improvement of +3.03 points (95% CI, 1.08-4.98; I = 88%). Pooled proportion estimates for dural tears, CSF leaks, infections, and early neurological deficits were 18.4% (95% CI, 12.6-26.1; I = 0%), 12.1% (95% CI, 6.6-21.2; I = 0%), 5.8% (95% CI, 2.1-15.4; I = 0%), and 5.7% (95% CI, 2.2-14.3; I = 0%), respectively.
CONCLUSION
Thoracic myelopathy secondary to OLF can be treated with laminectomy. However, despite some improvement in JOA score, functional status remains poor postoperatively. Perioperative complications are common, with dural tears and CSF leaks occurring most frequently. OLF is an uncommon condition and more research is needed to better understand how we can improve the outcomes of laminectomy alone for the treatment of thoracic myelopathy due to OLF.
LEVEL OF EVIDENCE
研究设计
系统评价和荟萃分析。
目的
研究黄韧带骨化（OLF）导致的胸椎管狭窄后路减压术后的功能结果和并发症。
背景资料总结
OLF 是一种罕见的疾病，可导致胸椎管狭窄。后路减压术是一种可以在 OLF 导致的胸椎管狭窄患者中进行的手术。很少有研究探讨 OLF 引起的胸椎管狭窄后路减压术后的术后结果和并发症。
方法
进行了系统评价和荟萃分析。文献检索产生了符合我们选择标准的 6 项研究。从每项研究中提取研究特征和基线患者人口统计学资料。主要结果包括术前和术后日本矫形协会（JOA）评分以及围手术期并发症，包括硬脑膜撕裂、脑脊液（CSF）漏、神经功能缺损、手术部位感染和其他并发症。我们使用随机效应模型计算 JOA 评分和并发症的汇总比例估计值。
结果
共纳入 137 例患者。汇总的术前和术后 JOA 评分分别为 5.08（95%置信区间[CI]，2.70-7.47；I=98%）和 8.29（95%CI，7.73-8.85；I=18%），平均改善+3.03 分（95%CI，1.08-4.98；I=88%）。硬脑膜撕裂、CSF 漏、感染和早期神经功能缺损的汇总比例估计值分别为 18.4%（95%CI，12.6-26.1；I=0%）、12.1%（95%CI，6.6-21.2；I=0%）、5.8%（95%CI，2.1-15.4；I=0%）和 5.7%（95%CI，2.2-14.3；I=0%）。
结论
OLF 引起的胸椎管狭窄症可以通过后路减压术治疗。然而，尽管 JOA 评分有所改善，但术后功能状态仍较差。围手术期并发症很常见，最常见的是硬脑膜撕裂和 CSF 漏。OLF 是一种罕见的疾病，需要更多的研究来更好地了解如何单独通过后路减压术来改善 OLF 引起的胸椎管狭窄症的治疗效果。
证据水平
3 级。
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