目的:本研究旨在对现有文献进行全面总结,并对前路可控前移融合术(ACAF)和后路椎管成形术(LP)治疗颈椎后纵韧带多节段骨化症(OPLL)的临床疗效进行系统评价。
方法:我们对数据库进行了电子搜索,包括PubMed,Embase,科克伦图书馆,和CNKI,从初始数据库开始到2023年3月。我们分析了各种参数,包括人口统计数据,操作时间,术中失血,颈椎曲度,日本骨科协会(JOA)评分,视觉模拟量表(VAS)评分,术后并发症。两名独立审稿人筛选了这些文献,提取的数据,并评估纳入研究的偏倚风险。采用RevMan5.4软件进行Meta分析。
结果:我们的评估包括7项研究,共涉及467名患者。患者队列分为两组:A组(ACAF)包括226名患者,而B组(LP)包括241例患者。总的来说,我们的统计分析显示两组在术中出血量方面有显著差异(P<0.05),手术时间,JOA得分,JOA评分改善率,术后VAS评分,术后颈椎曲度,以及某些术后并发症的发生率(C5神经根麻痹,吞咽困难,和轴向症状)。然而,两组术后脑脊液漏发生率及术后总并发症比较,差异无统计学意义(P>0.05)。
结论:这项研究的结果表明,在多级子宫颈OPLL的治疗中,与LP相比,ACAF产生更好的结果。具体来说,ACAF改善术后神经功能,减少术后疼痛,降低术中失血量,改善术后颈椎曲度,并降低C5神经根麻痹和术后轴性症状的发生率。尽管如此,ACAF与更长的手术时间和更高的术后吞咽困难的发生率相关。尽管术后并发症的总体发生率相似。重要的是要注意,由于样本量有限和纳入研究的质量参差不齐,这些结论应谨慎解释。涉及更大的进一步研究,需要高质量的研究来验证这些发现.
This study aims to provide a comprehensive summary of the existing literature and conduct a systematic evaluation of the clinical outcomes associated with anterior controllable antedisplacement and fusion (ACAF) and posterior laminoplasty (LP) for the treatment of multisegment ossification of the cervical posterior longitudinal ligament (OPLL).
We conducted an electronic search of databases, including PubMed, Embase, Cochrane Library, and CNKI, from the inception of the initial database to March 2023. We analyzed various parameters, including demographic data, operation time, intraoperative blood loss, cervical curvature, Japanese Orthopaedic Association (JOA) scores, Visual Analog Scale (VAS) scores, and postoperative complications. Two independent reviewers screened the literature, extracted data, and assessed the risk of bias in the included studies. Meta-analysis was performed using RevMan 5.4 software.
Our evaluation encompassed 7 studies involving a total of 467 patients. The patient cohort was divided into 2 groups: Group A (ACAF) comprised 226 patients, while Group B (LP) comprised 241 patients. Overall, our statistical analysis revealed significant differences between the 2 groups (P < 0.05) in terms of intraoperative blood loss, operative time, JOA score, JOA score improvement rate, postoperative VAS score, postoperative cervical curvature, and the incidence of certain postoperative complications (C5 nerve root paralysis, dysphagia, and axial symptoms). However, there was no statistically significant difference in the incidence of postoperative cerebrospinal fluid leakage and postoperative total complications between the 2 groups (P > 0.05).
The findings of this study suggest that, in the treatment of multilevel cervical OPLL, ACAF yields superior outcomes compared to LP. Specifically, ACAF improves postoperative neurologic function, reduces postoperative pain, lowers intraoperative blood loss, improves postoperative cervical curvature, and decreases the incidence of C5 nerve root paralysis and postoperative axial symptoms. Nonetheless, ACAF is associated with longer operative times and a higher incidence of postoperative dysphagia, though the overall incidence of postoperative complications is similar. It is important to note that these conclusions should be interpreted cautiously due to the limited sample size and the variable quality of the included studies. Further research involving larger, high-quality studies is warranted to validate these findings.