颈后纵韧带骨化椎体前移与椎板成形的荟萃分析

A meta-analysis of anterior controllable antedisplacement and fusion versus laminoplasty for cervical ossification of the posterior longitudinal ligament

摘要:

[目的]采用荟萃分析评价颈椎椎体可控前移融合术（anterior controllable antedisplacement and fusion, ACAF）和后路椎板成形术（laminoplasty, LP）治疗颈椎后纵韧带骨化（ossification of the posterior longitudinal ligament, OPLL）的临床疗效。[方法]在 PubMed、Embase、Cochrane、Science Direct、中国知网等数据库进行文献检索并手工检索相关杂志，阅读全文提取效应量，使用 STATA 17.0 软件进行荟萃分析。[结果] ACAF 组术后 JOA 评分 （WMD=1.011, 95%CI 0.462~1.559, P＜0.001）、术后 JOA 评分改善率 （WMD=8.903, 95%CI 5.964~11.841, P＜0.05）、术后 VAS 评分 （WMD=-1.059, 95%CI -1.885~-0.232, P=0.012）、 术后颈椎曲度指数 （WMD=7.604, 95% CI 5.013~10.195, P＜0.05）、C₅ 神经根麻痹发生率 （OR=0.236, 95% CI 0.082~0.678, P= 0.007）、轴性症状发生率 （OR=0.148, 95%CI 0.042~0.525, P=0.003） 均显著优于 LP 组。但 ACAF 组的手术时间显著长于 LP 组 （WMD=90.593, 95%CI 47.949~133.237, P＜0.001）、术后吞咽困难发生率（OR=11.276, 95%CI 2.073~61.332, P=0.005）显著高于 LP 组。LP 组术后颈椎活动度 （WMD=-3.599, 95%CI -6.394~-0.804, P=0.012） 显著优于 ACAF 组。两组术中出血量 （WMD= -155.872, 95%CI -366.687~48.943, P=0.134）、脑脊液漏发生率（OR=0.983, 95%CI 0.337~2.871, P=0.976）、术后总并发症发生率 （OR=0.606, 95%CI 0.361~1.019, P=0.059）的差异均无统计学意义。[结论] ACAF 与 LP 两种术式在治疗 OPLL 时均能取得较好的临床效果，但 ACAF 术后神经功能恢复得更好，术后轴性症状、C₅神经根麻痹发生率更低。

Abstract:

[Objective] A meta-analysis was performed to evaluate the clinical outcomes of anterior controllable antedisplacement and fusion (ACAF) versus posterior laminoplasty (laminoplasty, LP) for the cervical ossification of the posterior longitudinal ligament (OPLL). [Methods] Literature search was conducted in PubMed, Embase, Cochrane, Science Direct, CNKI and other databases, with relevant journals manually searched, the full text was read and the effect data was extracted. Finally, STATA 17.0 software was used for meta-analysis. [Results] The ACAF group proved significantly superior to the LP group in terms of postoperative JOA score (WMD=1.011, 95%CI 0.462~ 1.559, P＜0.001), improvement rate of JOA score (WMD=8.903, 95%CI 5.964~11.841, P＜0.05), postoperative VAS score (WMD=-1.059, 95%CI -1.885~-0.232, P=0.012), postoperative cervical curvature index (WMD=7.604, 95%CI 5.013~10.195, P＜0.05), the incidence of C₅ nerve root paralysis (OR=0.236, 95%CI 0.082-0.678, P=0.007), and the incidence of axial symptoms (OR=0.148, 95%CI 0.042-0.525, P= 0.003), whereas the former was significantly inferior to the latter in terms of the operation time (WMD=90.593, 95%CI 47.949~133.237, P＜ 0.001), the incidence of postoperative dysphagia (OR=11.276, 95%CI 2.073~61.332, P=0.005), and postoperative cervical motion (WMD= -3.599, 95% CI -6.394~-0.804, P=0.012). However, there were no significant differences in terms of intraoperative blood loss (WMD= -155.872, 95%CI -366.687~48.943, P=0.134), incidence of cerebrospinal fluid leakage (OR=0.983, 95%CI 0.337~2.871, P=0.976) and in the total incidence of postoperative complications (OR=0.606, 95% CI 0.361~1.019, P=0.059). [Conclusion] Both ACAF and LP can achieve good clinical results in the treatment of OPLL, by comparison the ACAF takes advantages over the LP in terms of the neurological function recovery, the incidence of postoperative axial symptoms and C₅ nerve root paralysis.