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颈椎神经根病的手术治疗:前路颈椎减压融合术与后路椎间孔切开术的比较:一项随机对照试验的研究方案。

Operative treatment of cervical radiculopathy: anterior cervical decompression and fusion compared with posterior foraminotomy: study protocol for a randomized controlled trial.

机构信息

Department of Orthopedic Surgery, Örebro University School of Medical Sciences, Örebro University Hospital, Örebro, Sweden.

Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.

出版信息

Trials. 2021 Sep 8;22(1):607. doi: 10.1186/s13063-021-05492-2.

Abstract

BACKGROUND

Cervical radiculopathy is the most common disease in the cervical spine, affecting patients around 50-55 year of age. An operative treatment is common clinical praxis when non-operative treatment fails. The controversy is in the choice of operative treatment, conducting either anterior cervical decompression and fusion or posterior foraminotomy. The study objective is to evaluate short- and long-term outcome of anterior cervical decompression and fusion (ACDF) and posterior foraminotomy (PF) METHODS: A multicenter prospective randomized controlled trial with 1:1 randomization, ACDF vs. PF including 110 patients. The primary aim is to evaluate if PF is non-inferior to ACDF using a non-inferiority design with ACDF as "active control." The neck disability index (NDI) is the primary outcome measure, and duration of follow-up is 2 years.

DISCUSSION

Due to absence of high level of evidence, the authors believe that a RCT will improve the evidence for using the different surgical treatments for cervical radiculopathy and strengthen current surgical treatment recommendation.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04177849. Registered on November 26, 2019.

摘要

背景

神经根型颈椎病是颈椎最常见的疾病,影响 50-55 岁左右的患者。当非手术治疗失败时,手术治疗是常见的临床实践。争议在于手术治疗的选择,是进行前路颈椎减压融合术(ACDF)还是后路椎间孔切开术(PF)。本研究的目的是评估前路颈椎减压融合术(ACDF)和后路椎间孔切开术(PF)的短期和长期疗效。

方法

这是一项多中心前瞻性随机对照临床试验,采用 1:1 随机分组,将 ACDF 与 PF 进行比较,共纳入 110 例患者。主要目的是采用非劣效性设计,以 ACDF 为“主动对照”,评估 PF 是否不劣于 ACDF。颈椎残障指数(NDI)是主要的观察指标,随访时间为 2 年。

讨论

由于缺乏高级别的证据,作者认为 RCT 将提高使用不同手术治疗神经根型颈椎病的证据水平,并加强当前的手术治疗建议。

试验注册

ClinicalTrials.gov NCT04177849. 注册于 2019 年 11 月 26 日。

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