Neurosurg Focus. 2021 Oct;51(4):E9. doi: 10.3171/2021.7.FOCUS21333.
Cervical fractures in patients with ankylosing spondylitis can have devastating neurological consequences. Currently, several surgical approaches are commonly used to treat these fractures: anterior, posterior, and anterior-posterior. The relative rarity of these fractures has limited the ability of surgeons to objectively determine the merits of each. The authors present an updated systematic review and meta-analysis investigating the utility of anterior surgical approaches relative to posterior and anterior-posterior approaches.
After a comprehensive literature search of the PubMed, Cochrane, and Embase databases, 7 clinical studies were included in the final qualitative and 6 in the final quantitative analyses. Of these studies, 6 compared anterior approaches with anterior-posterior and posterior approaches, while 1 investigated only an anterior approach. Odds ratios and 95% confidence intervals were calculated where appropriate.
A meta-analysis of postoperative neurological improvement revealed no statistically significant differences in gross rates of neurological improvement between anterior and posterior approaches (OR 0.40, 95% CI 0.10-1.59; p = 0.19). However, when analyzing the mean change in neurological function, patients who underwent anterior approaches had a significantly lower mean change in postoperative neurological function relative to patients who underwent posterior approaches (mean difference [MD] -0.60, 95% CI -0.76 to -0.45; p < 0.00001). An identical trend was seen between anterior and anterior-posterior approaches; there were no statistically significant differences in gross rates of neurological improvement (OR 3.05, 95% CI 0.84-11.15; p = 0.09). However, patients who underwent anterior approaches experienced a lower mean change in neurological function relative to anterior-posterior approaches (MD -0.46, 95% CI -0.60 to -0.32; p < 0.00001). There were no significant differences in complication rates between anterior approaches, posterior approaches, or anterior-posterior approaches, although complication rates trended lower in patients who underwent anterior approaches.
The results of this review and meta-analysis demonstrated the varying benefits of anterior approaches relative to posterior and anterior-posterior approaches in treatment of cervical fractures associated with ankylosing spondylitis. While reports demonstrated lower degrees of neurological improvement in anterior approaches, they may benefit patients with less-severe injuries if lower complication rates are desired.
强直性脊柱炎患者的颈椎骨折可能会导致严重的神经后果。目前，有几种常用的手术方法来治疗这些骨折：前路、后路和前后路。这些骨折的相对罕见性限制了外科医生客观确定每种方法优点的能力。作者提出了一项更新的系统评价和荟萃分析，研究前路手术相对于后路和前后路手术的效用。
在对 PubMed、Cochrane 和 Embase 数据库进行全面文献检索后，有 7 项临床研究被纳入最终的定性分析，有 6 项纳入最终的定量分析。这些研究中，有 6 项研究比较了前路与前后路，有 1 项仅研究了前路。在适当的情况下计算了比值比和 95%置信区间。
一项关于术后神经改善的荟萃分析显示，前路与后路在神经改善的总发生率方面无统计学差异（OR 0.40，95%CI 0.10-1.59；p = 0.19）。然而，在分析神经功能的平均变化时，接受前路手术的患者术后神经功能的平均变化明显低于接受后路手术的患者（平均差值[MD] -0.60，95%CI -0.76 至 -0.45；p < 0.00001）。前路与前后路之间也存在相同的趋势；神经改善的总发生率无统计学差异（OR 3.05，95%CI 0.84-11.15；p = 0.09）。然而，接受前路手术的患者神经功能的平均变化低于前后路手术（MD -0.46，95%CI -0.60 至 -0.32；p < 0.00001）。前路、后路和前后路手术的并发症发生率之间无显著差异，尽管前路手术的并发症发生率较低。
本综述和荟萃分析的结果表明，前路相对于后路和前后路在治疗强直性脊柱炎相关颈椎骨折方面具有不同的优势。虽然报告显示前路的神经改善程度较低，但如果需要较低的并发症发生率，它们可能对神经损伤较轻的患者有益。
