方法:系统评价。
目的:评估颈椎前路椎间盘切除融合术(ACDF)和颈椎前路椎体切除融合术(ACCF)哪种颈椎畸形矫正技术能产生更好的临床效果,射线照相,和手术结果。
方法:我们进行了一项荟萃分析,比较了涉及ACDF和ACCF的研究。包括患有原始或先前治疗过的颈椎畸形的成年患者。两名独立评审员将提取的数据分类为临床,射线照相,和手术结果,包括并发症。临床评估包括患者报告的结果;影像学评估检查C2-C7Cobb角,T1斜率,T1-CL,C2-7SVA,和移植物稳定性。手术措施包括手术时间,失血,住院,和并发症。
结果:26项研究(25727例患者)符合纳入标准并被提取。其中,荟萃分析中纳入了14项具有低偏倚风险的研究(19077例患者)。ACDF和ACCF同样改善了JOA和NDI的临床结果,但ACDF在实现较低的VAS颈部评分方面明显更好。ACDF还更有利于改善宫颈前凸和最小化移植并发症的发生率。虽然大多数手术并发症的方法之间没有显着差异,ACDF有利于减少手术时间,术中失血,和住院时间。
结论:虽然这两种技术都有益于颈椎畸形患者,当两种技术都可行时,ACDF可能优于VAS颈部评分,宫颈前凸,移植物并发症和某些围手术期结果。建议进一步研究以解决结果变异性并改进手术方法选择。
METHODS: Systematic Review.
OBJECTIVE: To evaluate which cervical deformity correction technique between anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) produces better clinical, radiographic, and operative outcomes.
METHODS: We conducted a meta-analysis comparing studies involving ACDF and ACCF. Adult patients with either original or previously treated cervical spine deformities were included. Two independent reviewers categorized extracted data into clinical, radiographic, and operative outcomes, including complications. Clinical assessments included patient-reported outcomes; radiographic evaluations examined C2-C7 Cobb angle, T1 slope, T1-CL, C2-7 SVA, and graft stability. Surgical measures included surgery duration, blood loss, hospital stay, and complications.
RESULTS: 26 studies (25727 patients) met inclusion criteria and were extracted. Of these, 14 studies (19077 patients) with low risk of bias were included in meta-analysis. ACDF and ACCF similarly improve clinical outcomes in terms of JOA and NDI, but ACDF is significantly better at achieving lower VAS neck scores. ACDF is also more advantageous for improving cervical lordosis and minimizing the incidence of graft complications. While there is no significant difference between approaches for most surgical complications, ACDF is favorable for reducing operative time, intraoperative blood loss, and length of hospital stay.
CONCLUSIONS: While both techniques benefit cervical deformity patients, when both techniques are feasible, ACDF may be superior with respect to VAS neck scores, cervical lordosis, graft complications and certain perioperative outcomes. Further studies are recommended to address outcome variability and refine surgical approach selection.