颈前路与后路内固定系统置入治疗多节段脊髓型颈椎病的Meta分析

背景：目前以植入物置入稳定脊柱的方法治疗多节段脊髓型颈椎病的主要置入路径为前路入路和后路入路，如何选择存在争议。 目的：对于前路与后路入路治疗多节段脊髓型颈椎病的疗效及安全性进行比较。 方法：检索 MEDLINE、EMBASE、PubMed数据库、万方以及中国知网等数据库中有关前路与后路入路方式治疗多节段脊髓型颈椎病的相关研究和文献，对颈椎前路组和颈椎后路组患者置入治疗时间、治疗中出血量、治疗前JOA评分、治疗后JOA评分、并发症发生率、邻近节段退变发生率、颈椎活动度以及再手术率等指标进行比较。 结果与结论：12篇研究符合纳入标准，累计病例790例，其中前路组359 例，后路组 431例。Meta分析表明前路组与后路组治疗前JOA评分、治疗时间、治疗中出血量比较差异无显著性意义(P > 0.05)。与后路组相比，前路组治疗后JOA评分高(P < 0.001)，临近节段退变发生率高(P=0.02)，颈椎活动范围大(P=0.001)，并发症发生率高(P=0.000 2)，再手术率较高(P < 0.000 1)。结果可见前路与后路治疗脊髓型颈椎病的手术创伤相似，但前路组神经功能改善较好，后路组并发症发生率较低，故临床上应依据实际情况合理选择入路方式。中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程全文链接：

Anterior approach versus posterior approach for multilevel cervical spondylotic myelopathy: a meta-analysis

BACKGROUND:Currently, the treatment of multilevel cervical spondylotic myelopathy mainly contains anterior approach surgery and posterior approach surgery, but how to choose the incision is still controversial. OBJECTIVE:To compare the therapeutic effect and safety of anterior and posterior approaches for the treatment of multilevel cervical spondylotic myelopathy. METHODS:Databases such as MEDLINE, EMBASE, PubMed, Wanfang data and China National Knowledge Infrastructure were searched about related research and literature on anterior and posterior approaches for the treatment of multilevel cervical spondylotic myelopathy. Operative time, amount of blood loss, preoperative Japanese Orthopedic Association score, postoperative Japanese Orthopedic Association score, complication rate, degeneration rate of adjacent segments, cervical range of motion and reoperation rate were compared between anterior and posterior groups. RESULTS AND CONCLUSION: 12 studies were accorded with the inclusion criteria, totally containing 790 cases (359 cases in the anterior group, and 431 cases in the posterior group). Meta-analysis showed that no significant difference in preoperative Japanese Orthopedic Association score, operative time and intraoperative amount of blood loss was detected between the anterior posterior and posterior groups (P > 0.05). Compared with the posterior group, Japanese Orthopedic Association scores were higher (P < 0.001), degeneration rate of adjacent segments was higher (P=0.02), cervical range of motion was bigger (P=0.001), complication rate was higher (P=0.000 2), and the reoperation rate was higher (P < 0.000 1) in the anterior group postoperation. Results showed that surgical invasion between anterior and posterior surgical groups in treatment of cervical myelopathy was similar, but the neurological improvement of anterior group was better, while complication rate of posterior group was lower. Therefore, the choice of surgical approach should be based on clinical practice.