胸脊髓病手术治疗的系统评价。
A systematic review of surgical procedures on thoracic myelopathy.
机构信息
Departmen of Orthopedics, Capital Medical University Affiliated Beijing Chaoyang Hospital, Capital Medical University, NO.8 Gongtinanlu, Beijing, 100020, People's Republic of China.
出版信息
J Orthop Surg Res. 2020 Dec 10;15(1):595. doi: 10.1186/s13018-020-02081-y.
PURPOSE
The surgical treatment of thoracic myelopathy is still controversial and also a challenge for spine surgeons. Therefore, the objective of this study was to review the related literature on the surgical treatment of thoracic myelopathy and try to define treatment guidelines for spine surgeons on thoracic myelopathy.
METHODS
Relevant literatures were searched based on the PubMed, EMBASE, and Cochrane Library between January 2008 and December 2018. Some data on the characteristics of patients were extracted, including number of patients, mean age, surgical procedures, blood loss, complications, and pre-/post-operation modified JOA score. Recovery rate was used to assess the effect of surgery outcome, and the safety was evaluated by blood loss and incidence of complications.
RESULTS
Thirty-five studies met the inclusion criteria and were retrieved. A total of 2183 patients were included in our systematic review, with the average age of 55.2 years. There were 69.8% patients diagnosed as ossification of ligamentum flavum (OLF), 20.0% as ossification of posterior longitudinal ligament (OPLL), 9.3% as disk herniation (DH), and 0.9% as others including diffuse idiopathic skeletal hyperostosis (DISH) and ankylosing spondylitis (AS). The volume of blood loss was more in the treatment of circumferential decompression (CD) than posterior decompression (PD), and the incidence of complications was higher in CD (P < 0.05). The volume of blood loss in minimally invasive surgery (MIS) was lowest and the incidence of complications was 19.2%. Post-operation recovery rate was 0.49 in PD, 0.35 in CD, and 0.29 in MIS while the recovery rate was 0.54 in PD, 0.55 in CD, and 0.49 in MIS at the last follow-up. When focusing on the OLF specifically, incidence of complications in PD was much lower than CD, with less blood loss and higher recovery rate. Focusing on the OPLL specifically, incidence of complications in PD was much lower than CD, with less blood loss while there was no statistical difference in recovery rate between these two methods.
CONCLUSIONS
This systematic review showed that posterior decompression for thoracic myelopathy is safer and better than circumferential decompression according to the complication rate and surgical outcome. And we should also consider the location of compression before the operation.
目的
胸椎脊髓病的手术治疗仍然存在争议，也是脊柱外科医生面临的挑战。因此，本研究的目的是回顾胸椎脊髓病的手术治疗相关文献，并尝试为脊柱外科医生制定胸椎脊髓病的治疗指南。
方法
根据 PubMed、EMBASE 和 Cochrane Library 数据库，检索 2008 年 1 月至 2018 年 12 月期间的相关文献。提取患者特征的一些数据，包括患者数量、平均年龄、手术方式、出血量、并发症以及术前和术后改良日本骨科协会（JOA）评分。恢复率用于评估手术结果，出血量和并发症发生率用于评估手术安全性。
结果
符合纳入标准的研究共有 35 项，共纳入 2183 例患者，平均年龄为 55.2 岁。其中，69.8%的患者被诊断为黄韧带骨化（OLF），20.0%的患者为后纵韧带骨化（OPLL），9.3%的患者为椎间盘突出（DH），0.9%的患者为弥漫性特发性骨肥厚（DISH）和强直性脊柱炎（AS）等其他疾病。全环减压（CD）的出血量多于单纯后路减压（PD），并发症发生率也高于 PD（P<0.05）。微创手术（MIS）的出血量最低，并发症发生率为 19.2%。PD 的术后恢复率为 0.49，CD 为 0.35，MIS 为 0.29，而 PD 的末次随访恢复率为 0.54，CD 为 0.55，MIS 为 0.49。专门针对 OLF 时，PD 的并发症发生率明显低于 CD，出血量更少，恢复率更高。专门针对 OPLL 时，PD 的并发症发生率明显低于 CD，出血量更少，但两种方法的恢复率无统计学差异。
结论
本系统评价显示，根据并发症发生率和手术效果，胸椎脊髓病后路减压比全环减压更安全、效果更好。并且，我们还应该在手术前考虑压迫的位置。
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