背景:目前,自锁独立笼(SSC)通常应用于颈椎前路椎间盘切除术和融合术(ACDF),如笼板结构(CPC)。然而,这两个设备的长期有效性仍然存在争议。我们的目的是比较SSC与CPC在单节段ACDF中的长期有效性。
方法:查询了四个电子数据库,以确定比较单节段ACDF中SSC与CPC的研究。使用StataMP17.0软件包进行荟萃分析。
结果:纳入了10项979名患者的试验。与CPC相比,SSC显著缩短手术时间,术中失血,住院时间,最终随访时的宫颈Cobb角,术后1个月吞咽困难率,以及末次随访时相邻节段退变(ASD)的发生率。术后1个月颈椎Cobb角无显著性差异,JOA得分,NDI得分,最终随访时的融合率和网箱沉降率。
结论:两种器械在单节段ACDF的JOA评分方面取得了相似的长期疗效,NDI得分,融合率和网箱沉降率。SSC在减少手术时间方面比CPC具有显著优势,术中出血,住院时间,以及手术后吞咽困难和ASD的发生率。因此,在单节段ACDF中,SSC比CPC更好。然而,在长期随访中,SSC在维持颈椎曲度方面不如CPC。放射学变化是否影响临床症状需要在随访时间较长的试验中确认。
BACKGROUND: Currently, self-locking stand-alone cages (SSC) are commonly applied in anterior cervical discectomy and fusion (ACDF), as are cage-plate constructs (CPC). However, it remains controversial concerning the long-term effectiveness of both apparatuses. Our purpose is to compare long-term effectiveness of SSC with CPC in monosegmental ACDF.
METHODS: Four electronic databases were queried to identify studies comparing SSC versus CPC in monosegmental ACDF. The meta-analysis was carried out with the use of the Stata MP 17.0 software package.
RESULTS: Ten trials with 979 patients were included. Compared to CPC, SSC significantly reduced operative time, intraoperative blood loss, duration of hospitalisation, cervical Cobb angle at final follow-up, 1-month postoperative dysphagia rate, and incidence of adjacent segment degeneration (ASD) at final follow-up. No significant difference was found regarding 1-month postoperative cervical Cobb angle, JOA scores, NDI scores, fusion rate and cage subsidence rate at final follow-up.
CONCLUSIONS: Both devices achieved similar long-term effectiveness in monosegmental ACDF regarding JOA scores, NDI scores, fusion rate and cage subsidence rate. SSC had significant advantages over CPC in reducing surgical duration, intraoperative bleeding, duration of hospitalisation, as well as rates of dysphagia and ASD after surgery. Therefore, SSC is a better option than CPC in monosegmental ACDF. However, SSC is inferior to CPC in maintaining cervical curvature at long-term follow-up. Whether radiological changes affect clinical symptoms needs confirmation in trials with longer follow-up.