采用零切系统行前路颈椎间盘切除融合术治疗颈椎病的Meta 分析。

Anterior Cervical Discectomy and Fusion Using Zero-P System for Treatment of Cervical Spondylosis: A Meta-Analysis.

机构信息

Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao 266003, China.

Department of Rehabilitation, Affiliated Hospital of Qingdao University, Qingdao 266003, China.

出版信息

Pain Res Manag. 2021 Dec 16;2021:3960553. doi: 10.1155/2021/3960553. eCollection 2021.

OBJECTIVE

The current study aimed to explore the efficacy of Zero profile intervertebral fusion system (Zero-P) and traditional anterior plate cage system (PC) in the treatment of cervical spondylotic myelopathy (CSM). Further, the present study evaluated effects of the treatments on medical security, height of intervertebral disc, adjacent-level ossification development (ALOD), and adjacent segmentation disease (ASD) through a systematic retrospective analysis.

METHODS

Studies on Zero-P system and traditional anterior plate cage system for ACDF in the treatment of CSM were searched in PubMed, Web of Science, Ovid, Embase, and Cochrane Library databases. Two independent researchers screened articles, extracted data, and evaluated the quality of the articles based on the inclusion and exclusion criteria of the current study. RevMan5.3 software was used for meta-analysis following the guidelines of Cochrane collaboration network. Cervical curvature, interbody fusion rate, preoperative and postoperative disc height index (DHI), fusion cage sinking rate, postoperative dysphagia, ASD, ALOD, and loosening of screw were compared between the two groups.

RESULTS

A total of 17 literatures were included in the present study, including 6 randomized controlled trials and 11 observational studies. The studies comprised a total of 1204 patients with CSM, including 605 patients in the Zero-P system group (Zero-P group) and 599 patients in the traditional animal plate cage group (PC group). Results of this meta-analysis showed that postoperative dysphagia [OR = 0.40, CI (0.28, 95% 0.58), < 0.00001], ALOD [OR = 0.09, CI (0.02, 95% 0.39), = 0.001], ASD [OR = 0.42, CI (0.20, 95% 0.86), = 0.02], and screw loosening [OR = 0.20, CI (0.08, 95% 0.52), = 0.0009] of the Zero-P group were significantly lower compared with the PC group. On the other hand, preoperative cervical curvature [WMD = -0.23, CI (-1.38, 95% 0.92), = 0.69], postoperative cervical curvature [WMD = -0.38, CI (-1.77, 95% 1.01), = 0.59], cage sinking rate [OR = 1.41, CI [0.52, 95% 3.82], = 0.50], intervertebral fusion rate [OR = 0.76, CI (0.27, 95% 2.48), = 0.38], preoperative DHI [WMD = -0.04, CI (-0.14, 95% 0.22), = 0.65], and postoperative DHI [WMD = 0.06, CI (-0.22, 95% 0.34), = 0.675] were not significantly different between the two groups.

CONCLUSION

It was evident that the Zero-P system used in ACDF is superior compared with the traditional anterior plate cage system in postoperative dysphagia, avoiding ALOD, ASD, and screw loosening.

目的

本研究旨在探讨 Zero profile 椎间融合系统（Zero-P）和传统前路板笼系统（PC）在治疗颈椎病（CSM）中的疗效。此外，本研究通过系统回顾性分析评估了两种治疗方法对医疗安全性、椎间盘高度、邻近节段骨化发育（ALOD）和邻近节段疾病（ASD）的影响。

方法

在 PubMed、Web of Science、Ovid、Embase 和 Cochrane Library 数据库中搜索 Zero-P 系统和传统前路板笼系统用于 ACDF 治疗 CSM 的研究。两名独立的研究人员根据本研究的纳入和排除标准筛选文章、提取数据并评估文章的质量。根据 Cochrane 协作网的指南，使用 RevMan5.3 软件进行荟萃分析。比较两组患者颈椎曲度、节段间融合率、术前和术后椎间盘高度指数（DHI）、融合笼下沉率、术后吞咽困难、ASD、ALOD、螺钉松动。

结果

本研究共纳入 17 篇文献，包括 6 项随机对照试验和 11 项观察性研究。这些研究共纳入 1204 例 CSM 患者，其中 Zero-P 系统组（Zero-P 组）605 例，传统动物板笼组（PC 组）599 例。荟萃分析结果显示，术后吞咽困难[OR=0.40，CI（0.28，95%0.58），<0.00001]、ALOD[OR=0.09，CI（0.02，95%0.39），=0.001]、ASD[OR=0.42，CI（0.20，95%0.86），=0.02]和螺钉松动[OR=0.20，CI（0.08，95%0.52），=0.0009]的发生率在 Zero-P 组明显低于 PC 组。另一方面，术前颈椎曲度[WMD=-0.23，CI（-1.38，95%0.92），=0.69]、术后颈椎曲度[WMD=-0.38，CI（-1.77，95%1.01），=0.59]、笼下沉率[OR=1.41，CI（0.52，95%3.82），=0.50]、节段间融合率[OR=0.76，CI（0.27，95%2.48），=0.38]、术前 DHI[WMD=-0.04，CI（-0.14，95%0.22），=0.65]和术后 DHI[WMD=0.06，CI（-0.22，95%0.34），=0.675]在两组之间无显著差异。