Zhao Chun-Ming, Chen Qian, Zhang Yu, Huang Ai-Bing, Ding Wen-Yuan, Zhang Wei
Department of Orthopaedic Surgery, The Affiliated Taizhou People's Hospital of Nantong University, Taizhou, Jiangsu Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Medicine (Baltimore). 2018 Aug;97(34):e11973. doi: 10.1097/MD.0000000000011973.
A meta-analysis was performed to compare the radiographic and surgical outcomes between anterior cervical discectomy and fusion (ACDF) and hybrid surgery (HS, corpectomy combined with discectomy) in the treatment for multilevel cervical spondylotic myelopathy (mCSM).
Both ACDF and HS are used to treat mCSM, however, which one is better treatment for mCSM remains considerable controversy.
An extensive search of literature was searched in PubMed/Medline, Embase, the Cochrane library, CNKI, and WANFANG databases on ACDF versus HS treating mCSM from January 2011 to December 2017. The following variables were extracted: blood loss, operation time, fusion rate, Cobb angles of C2-C7, total complications, dysphagia, hoarseness, C5 palsy, infection, cerebral fluid leakage, epidural hematoma, and graft subsidence. Data analysis was conducted with RevMan 5.3 and STATA 12.0.
A total of 4 studies including 669 patients were included in our study. The pooled analysis showed that there were no significant difference in the operation time, fusion rate, Cobb angles of C2-C7, dysphagia, hoarseness, C5 palsy, infection, cerebral fluid leakage, epidural hematoma, and graft subsidence. However, there were significant difference between 2 groups in blood loss [P < .00001, SMD = -30.29 (-45.06, -15.52); heterogeneity: P = .38, I = 0%= and total complications [P = .04, OR = 0.66 95%CI (0.44, 0.98); heterogeneity: P = .37, I = 4%].
Based on our meta-analysis, except for blood loss and total complications, both ACDF and hybrid surgery are effective options for the treatment of multilevel cervical spondylotic myelopathy.
进行一项荟萃分析，比较前路颈椎间盘切除融合术（ACDF）与混合手术（HS，椎体次全切除联合椎间盘切除术）治疗多节段脊髓型颈椎病（mCSM）的影像学和手术效果。
ACDF和HS均用于治疗mCSM，然而，哪种方法对mCSM是更好的治疗方法仍存在很大争议。
在PubMed/Medline、Embase、Cochrane图书馆、CNKI和万方数据库中广泛检索2011年1月至2017年12月期间关于ACDF与HS治疗mCSM的文献。提取以下变量：失血量、手术时间、融合率、C2-C7 Cobb角、总并发症、吞咽困难、声音嘶哑、C5麻痹、感染、脑脊液漏、硬膜外血肿和植骨沉降。使用RevMan 5.3和STATA 12.0进行数据分析。
本研究共纳入4项研究，包括669例患者。汇总分析显示，手术时间、融合率、C2-C7 Cobb角、吞咽困难、声音嘶哑、C5麻痹、感染、脑脊液漏、硬膜外血肿和植骨沉降方面无显著差异。然而，两组在失血量[P<0.00001，标准化均数差（SMD）=-30.29（-45.06，-15.52）；异质性：P=0.38，I²=0%]和总并发症[P=0.04，比值比（OR）=0.66，95%置信区间（CI）（0.44，0.98）；异质性：P=0.37，I²=4%]方面存在显著差异。
基于我们的荟萃分析，除失血量和总并发症外，ACDF和混合手术都是治疗多节段脊髓型颈椎病的有效选择。
