本文選題：頸椎人工間盤置換術(shù) + 頸前路椎間盤切除融合術(shù)��； 參考：《中國脊柱脊髓雜志》2017年04期

【摘要】：目的 :通過Meta分析系統(tǒng)評價頸椎人工間盤置換術(shù)(cervical total disc replacement,TDR)與頸前路椎間盤切除融合術(shù)(anterior cervical discectomy and fusion,ACDF)對鄰近節(jié)段退變(adjacent segment degeneration,ASDeg)、鄰近節(jié)段病(adjacent segment disease,ASDis)發(fā)生的影響。方法 :根據(jù)Cochrane系統(tǒng)評價指南,通過Pub Med、Medline、EMBASE、Cochrane圖書館、中國生物醫(yī)學文獻數(shù)據(jù)庫(CBM)和萬方數(shù)據(jù)庫(Wanfang Database)檢索2002年1月~2016年6月之間關(guān)于TDR和ACDF術(shù)后出現(xiàn)ASDeg、ASDis的隨機對照試驗(randomized controlled trials,RCTs),由兩名研究人員獨立篩選文章。納入文獻的方法學質(zhì)量和偏倚風險通過Cochrane系統(tǒng)評價指南進行評價,提取數(shù)據(jù)包括ASDeg、ASDis以及再手術(shù)率的相關(guān)信息,研究結(jié)果以ASDeg和ASDis的發(fā)生作為直接結(jié)果,以鄰近節(jié)段再手術(shù)率作為間接結(jié)果評估鄰近節(jié)段病變的發(fā)生,并根據(jù)隨訪時間和研究地點分層進行亞組分析,最終對整篇Meta分析通過證據(jù)質(zhì)量分級和推薦強度系統(tǒng)(the grades of recommendation,assessment,development and evaluation,GRADE)進行質(zhì)量評估。結(jié)果 :共納入了11篇RCTs,包括2632名研究對象。對于整體的ASD(包括直接和間接結(jié)果),TDR的發(fā)生率明顯低于ACDF(OR=0.6;95%CI[0.38,0.73];P0.00001),差異有統(tǒng)計學意義。ASDeg和再手術(shù)率方面,TDR相對于ACDF具有明顯優(yōu)勢(分別為OR=0.58,95%CI[0.46,0.72],P0.00001和OR=0.52,95%CI[0.30,0.87],P=0.01)。以隨訪時間5年為分界點,不論隨訪5年還是≥5年,在ASDeg發(fā)生率上,TDR的優(yōu)勢都比ACDF顯著(分別為OR=0.63,P=0.001;OR=0.49,P=0.0002),并且這種優(yōu)勢可能隨時間延長有擴大趨勢。以研究地點分層,不論在美國(7篇RCTs)還是中國(4篇RCTs),TDR在鄰近節(jié)段退變(ASDeg)發(fā)生率上均有優(yōu)勢(P0.0001,P=0.03)。根據(jù)GRADE評分,該Meta分析的質(zhì)量級別為中等質(zhì)量。結(jié)論:與ACDF相比,TDR在降低ASDeg和再手術(shù)率方面具有優(yōu)勢。
[Abstract]:Objective: to evaluate the effect of cervical total disc replacement (TDR) and anterior cervical discectomy and fusion (ACDF) on the occurrence of adjacent segment degeneration segment degenerative ASDega by Meta analysis system. Methods: according to the Cochrane system evaluation guidelines, the Pub Medline was used for the EMBASE Cochrane Library. Chinese Biomedical Literature Database (CBM) and Wanfang Database (Wanfang Database) were collected from January 2002 to June 2016. Randomized controlled trialsrcts were selected by two researchers. The methodological quality and bias risks included in the literature were evaluated through the Cochrane system evaluation guidelines, and data were extracted, including information on ASDegis and the rate of reoperation. The results of the study were based on the occurrence of ASDeg and ASDis. The rate of reoperation of adjacent segments was used as an indirect result to evaluate the occurrence of adjacent segment lesions, and subgroup analysis was performed based on follow-up time and site stratification. Finally, the whole Meta analysis was evaluated by using the grades of recommendation assessment and evaluation system and the evidence quality grading system. Results: 11 RCTs were included, including 2632 subjects. For the whole ASD (including direct and indirect results), the incidence of TDR was significantly lower than that of ACDF OR0.695CI [0.380.73] or P0.00001. The difference was statistically significant. ASDeg and the rate of reoperation were significantly superior to ACDF (OR0.5895CI [0.460.72] P0.00001 and OR0.529595 CI [0.300.87]). Taking 5 years of follow-up as the dividing point, whether for 5 years or 鈮，

本文編號：1845990