比较保留C_(7)棘突肌肉韧带复合体和传统椎管扩大成形术后轴性症状发生率的Meta分析

目的系统评价保留C_(7)棘突肌肉韧带复合体改良椎管扩大成形与传统椎管扩大成形手术治疗多节段颈椎病的临床疗效。方法计算机检索PubMed、Cochrane Central、EMbase、the ISI Web of Knowledge Database、知网、维普、万方数据库。检索时间为建库时间至2020年12月1日。纳入关于保留C_(7)棘突改良椎管扩大成形与传统椎管扩大成形两种手术方法治疗脊髓型颈椎病疗效比较的随机对照试验、前瞻性或回顾性研究。利用Rev-Man 5.3软件进行Meta分析。结果共有10篇研究符合纳入标准,共603例患者,改良组268例,传统组335例。Meta分析结果显示:改良组术后轴性症状发生率、VAS评分低于传统手术组(P<0.05),术后JOA评分改善率两者差异无统计学意义(P>0.05)。结论保留C_(7)棘突改良椎管扩大成形术与传统椎管扩大成形术治疗脊髓型颈椎病均的疗效相当,均可有效改善各项评分,前者可以有效降低术后轴性症状的发生率。

Meta-analysis of preservation of C7 muscle ligament complex laminoplasty versus conventional laminoplasty in treatment of multilevel cervical myelopathy

Objective To compare the effectiveness and the safety between preservation of C7 muscle ligament complex laminoplasty and conventional laminoplasty for the patients with multilevel cervical myelopathy(MCM). Methods A systematic search of all the studies published was conducted on the PubMed, Cochrane Central, EMbase, the ISI Web of Knowledge Database, CNKI, VIP and Wanfang databases. Randomized and non-randomized controlled trials that preservation of C7 muscle ligament complex laminoplasty and conventional laminoplasty for MCM were identified from database foundation to December 1, 2020. Meta-analyses were performed by using the Rev-Man 5.3 software. Results Ten studies involving 603 patients were included. Among the patients, 268 underwent preservation of C7 muscle ligament complex laminoplasty(modified group) and 335 underwent conventional laminoplasty(traditional group). The results of the meta-analysis indicated that, compared with traditional group, modified group has advantages of incidence of axial symptoms and postoperative VAS score(P<0.05), but the two groups had no statistical difference in JOA score recovery rate (P>0.05). Conclusion These results suggested that both traditional and modified surgery were demonstrated to be effective for MCM. Modified surgery had obvious advantages in incidence of axial symptoms.