本文選題：下頸椎 + 小關(guān)節(jié)脫位�。� 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:由于手術(shù)治療下頸椎小關(guān)節(jié)脫位的臨床預(yù)后優(yōu)于非手術(shù)治療,因此目前普遍采用手術(shù)策略來(lái)處理下頸椎小關(guān)節(jié)脫位。手術(shù)入路有多種,包括單純前路、后路以及前后聯(lián)合入路,但是治療下頸椎小關(guān)節(jié)脫位的手術(shù)入路選擇尚存爭(zhēng)議。本文應(yīng)用系統(tǒng)評(píng)價(jià)及meta分析的方法評(píng)價(jià)不同手術(shù)入路治療下頸椎小關(guān)節(jié)脫位的療效,以期為下頸椎小關(guān)節(jié)脫位手術(shù)方式的選擇提供循證醫(yī)學(xué)的證據(jù)支持。方法:計(jì)算機(jī)檢索PubMed(1966年至2016年6月)、EMbase(1974年至2016年6月)、Cochrane圖書(shū)館(2016年第6期)、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)(CBM,1978年至2016年6月)、相關(guān)期刊論文(CNKI,1994年至2016年6月)及萬(wàn)方數(shù)據(jù)庫(kù)(1998年至2016年6月),手工檢索相關(guān)的中英文骨科雜志和會(huì)議論文,收集不同手術(shù)入路治療下頸椎小關(guān)節(jié)脫位的隨機(jī)或非隨機(jī)對(duì)照研究,由兩名研究者按納入與排除標(biāo)準(zhǔn)選擇文獻(xiàn)、提取資料和質(zhì)量評(píng)價(jià)后,采用Re Man5.2軟件對(duì)可以合并分析的指標(biāo)進(jìn)行meta分析,對(duì)不能合并的指標(biāo)采用描述性分析。結(jié)果:共納入7篇文獻(xiàn),652例患者,其中前路手術(shù)患者290例,后路手術(shù)患者151例,前后聯(lián)合入路患者211例。分析結(jié)果顯示:前路的手術(shù)時(shí)間小于后路(WMD=-22.22,95%CI:-34.20~-10.24,P=0.0003)及前后聯(lián)合入路(WMD=-117.27,95%CI:-132.41~-102.12,P0.00001);前路的出血量小于后路(WMD=-255.33,95%CI:-306.81~-203.85,P0.00001)及前后聯(lián)合入路(WMD=-402.84,95%CI:-489.59~-316.09,P0.00001);前路與前后聯(lián)合入路的固定節(jié)段無(wú)統(tǒng)計(jì)學(xué)差異(WMD=-1.38,95%CI:-4.18~1.43,P=0.34),但均小于后路(WMD=-1.29,95%CI:-2.16~-0.42,P=0.004);前路的術(shù)后椎體水平位移小于后路(WMD=-0.06,95%CI:-0.10~-0.03,P=0.0004)及前后聯(lián)合入路(WMD=-1.67,95%CI:-2.60~-0.74,P=0.0004);前路與后路的術(shù)后Cobb角無(wú)統(tǒng)計(jì)學(xué)差異(WMD=-0.18,95%CI:-0.61~0.26,P=0.42),但小于前后聯(lián)合入路(WMD=-1.29,95%CI:-2.25~-0.33,P=0.008)。結(jié)論:雖然不同手術(shù)入路均有較好的臨床療效,但就手術(shù)入路本身而言,前路手術(shù)的優(yōu)勢(shì)較明顯。由于存在納入研究數(shù)量及方法學(xué)質(zhì)量的局限性,還需要進(jìn)行大樣本、高質(zhì)量的隨機(jī)對(duì)照研究以得出更加可信的結(jié)論。
[Abstract]:Objective: the surgical treatment of the lower cervical joint dislocation is superior to the non operative treatment. Therefore, the surgical strategy is widely used to deal with the dislocation of the lower cervical spine. There are many surgical approaches, including simple anterior, posterior and combined approach, but the choice of surgical approach for the lower cervical joint dislocation is still controversial. The results of systematic evaluation and meta analysis were used to evaluate the effect of different surgical approaches to the lower cervical joint dislocation to provide evidence-based support for the selection of the operation mode of the lower cervical joint dislocation. Methods: computer retrieval of PubMed (1966 to June 2016), EMbase (1974 to June 2016), Cochrane Library (2) 016 years and sixth years), Chinese biomedical literature database (CBM, 1978 to June 2016), Chinese journal full text database (CNKI, 1994 to June 2016) and Wanfang database (1998 to June 2016), manually retrieving relevant Chinese and English Department of orthopedics magazines and conference papers to collect random or random dislocation of the lower cervical joints under different surgical approaches. In the non randomized controlled study, after two researchers selected the literature, extracted data and quality evaluation according to the inclusion and exclusion criteria, the Re Man5.2 software was used to perform meta analysis on the indexes that could be combined and analyzed. A descriptive analysis was used for the indexes that could not be merged. Results: a total of 7 articles were included and 652 patients, including 290 cases of anterior surgery, and the posterior approach, were included. The results showed that the operative time of the anterior approach was less than that of the posterior approach (WMD=-22.22,95%CI:-34.20~-10.24, P=0.0003) and the anterior and posterior approach (WMD=-117.27,95%CI:-132.41~-102.12, P0.00001). The amount of bleeding in the anterior approach was less than that of the posterior approach (WMD=-255.33,95%CI:-306.81~-203.85, P0.00001) and the combination of anterior and posterior (WMD=-255.33,95%CI:-306.81~-203.85, P0.00001). WMD=-402.84,95%CI:-489.59~-316.09 (P0.00001); there was no statistical difference between the fixed segments of the anterior and anterior anterior and posterior approaches (WMD=-1.38,95%CI:-4.18~1.43, P=0.34), but less than the posterior approach (WMD=-1.29,95%CI:-2.16~-0.42, P=0.004); the horizontal displacement of the vertebral body after the anterior approach was smaller than that of the posterior (WMD=-0.06,95%CI:-0.10~-0.03, P=0.0004) and the anterior and posterior approach (WMD=-0.06,95%CI:-0.10~-0.03, P=0.0004). WMD=-1.67,95%CI:-2.60~-0.74 (P=0.0004); there was no statistical difference between the anterior and posterior approach Cobb angles (WMD=-0.18,95%CI:-0.61~0.26, P=0.42), but less than the anterior and posterior approach (WMD=-1.29,95%CI:-2.25~-0.33, P=0.008). Conclusion: Although different surgical approaches have better clinical efficacy, the anterior approach to the surgical approach itself is the anterior approach. The advantages of surgery are obvious. Due to the limitations of the quantity and methodological quality of the study, large samples and high quality randomized controlled studies are needed to draw more credible conclusions.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R687.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 田鵬;屈萬(wàn)明;秦小容;;下頸椎骨折脫位治療的術(shù)式選擇[J];現(xiàn)代儀器與醫(yī)療;2016年03期

2 余成誠(chéng);郝定均;;下頸椎關(guān)節(jié)脫位治療進(jìn)展[J];中華骨與關(guān)節(jié)外科雜志;2015年03期

3 雷倉(cāng)武;杜洪華;馬禮明;;下頸椎創(chuàng)傷骨折脫位手術(shù)治療分析[J];浙江創(chuàng)傷外科;2014年05期

4 李興艷;程浩;李鋒;陳安民;郭風(fēng)勁;;不同手術(shù)入路治療外傷性下頸椎骨折脫位的療效比較[J];骨科;2014年02期

5 李東;姜立義;高宗伯;;不同手術(shù)入路治療無(wú)椎體骨折的下頸椎小關(guān)節(jié)脫位的臨床效果對(duì)比分析[J];中國(guó)醫(yī)藥科學(xué);2012年17期

6 趙宏;王杰;李純志;方煜;;不同手術(shù)入路治療無(wú)椎體骨折的下頸椎小關(guān)節(jié)脫位[J];脊柱外科雜志;2011年01期

7 房巍;;下頸椎骨折脫位的臨床治療體會(huì)[J];中國(guó)醫(yī)藥指南;2011年01期

8 洪建斌;楊子斌;王正祥;阮安陪;;下頸椎骨折脫位的臨床治療體會(huì)[J];中國(guó)醫(yī)藥指南;2010年23期

9 何斌;蔡小軍;韓建華;鄢家強(qiáng);;影響下頸椎骨折脫位閉合復(fù)位的相關(guān)因素探討[J];遵義醫(yī)學(xué)院學(xué)報(bào);2009年04期

10 沈茂榮;;頸椎微創(chuàng)外科技術(shù)發(fā)展近況[J];微創(chuàng)醫(yī)學(xué);2007年04期

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