颈前板限制性和非限制性固定早期融合效果的比较
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摘要
目的通过Meta分析和综述比较的方法探讨颈前板限制性和非限制性2种固定方式对术后早期融合效果的影响。方法应用循证医学的方法在中英文数据库中系统检索颈前板限制性固定与非限制性固定早期融合率的相关文献,文献发表时间为2000年1月至2017年7月。英文数据库包括Embase数据库、Clinical Trial数据库、PubMed数据库、Cochrane Library数据库以及Springer Link数据库等,检索词包括"anterior cervical plate"、"fusion"、"static"、"dynamic"、"lock"、"non-lock"、"fixed"、"variable"、"constraint"、"unconstraint"、"restriction"和"non-restriction"。中文数据库包括CHKD期刊全文数据库(CNKI)、万方医学期刊数据库(万方)、中国生物医学文献数据库(CBM)等,检索词包括"颈"、"颈椎"、"前路"、"固定"、"动态"、"活动"、"静力"、"动力"、"限制""非限制"、"板"和"融合"等。采用STATA 14.2统计学软件对文献中报道的术后早期(4~9个月)融合率进行Meta分析。结果共纳入文献8篇,包括5篇英文文献和3篇中文文献。8篇文献报道的病例中,限制性固定组230例,非限制性固定组253例。Meta分析结果显示,术后平均6.8个月限制性和非限制性固定早期融合率的区间分别为95%CI:64.27%~100%和95%CI:69.48%~97.32%,2种固定方式的融合率差异无统计学意义(P>0.05)。对纳入的文献进行异质性检验,发现OR=1.35>1,无异质性,且无发表偏倚,敏感性分析结果可靠。结论颈前板限制性和非限制性固定在促进植骨融合和提高术后早期融合率方面差异不显著。
Objective To compare the effect on the early fusion of constrained fixation and unconstrained fixation in anterior cervical plate system by using various statistical methods.MethodsThe related literatures in English and Chinese published between January 2000 and July 2017 were systematically searched.The English databases included Embase,Clinical Trial,PubMed,Cochrane Library,Springer Link,etc.Keywords related to the study included"anterior cervical plate","fusion","static","dynamic","lock","nonlock","fixed","variable","constraint","unconstraint","restriction"and"non-restriction".The Chinese databases included CNKI,Wanfang,Chinese Biomedical Literature,etc.STATA 14.2 version was used for Meta-analysis to compare the early fusion rates at 4-9 months postoperatively.Results A total of 8 articles(5 English articles and 3 Chinese articles)were included.Of these reported cases,230 patients were in constrained fixation group,and 253 patients were in unconstrained fixation group.Mete-analysis showed that at average 6.8 months after surgery,the fusion rates of constrained fixation and unconstrained fixation were not significant different(95%CI:64.27%~100%vs.95%CI:69.48%~97.32%,P>0.05).The included literatures were found with no heterogeneity(OR=1.35>1)and no publication bias,and the results of sensitivity analysis were reliable.Conclusion Constrained fixation and unconstrained fixation of the anterior cervical plate are not significantly different in promoting bone graft fusion and improving early postoperative fusion rate.
Objective To compare the effect on the early fusion of constrained fixation and unconstrained fixation in anterior cervical plate system by using various statistical methods.MethodsThe related literatures in English and Chinese published between January 2000 and July 2017 were systematically searched.The English databases included Embase,Clinical Trial,PubMed,Cochrane Library,Springer Link,etc.Keywords related to the study included"anterior cervical plate","fusion","static","dynamic","lock","nonlock","fixed","variable","constraint","unconstraint","restriction"and"non-restriction".The Chinese databases included CNKI,Wanfang,Chinese Biomedical Literature,etc.STATA 14.2 version was used for Meta-analysis to compare the early fusion rates at 4-9 months postoperatively.Results A total of 8 articles(5 English articles and 3 Chinese articles)were included.Of these reported cases,230 patients were in constrained fixation group,and 253 patients were in unconstrained fixation group.Mete-analysis showed that at average 6.8 months after surgery,the fusion rates of constrained fixation and unconstrained fixation were not significant different(95%CI:64.27%~100%vs.95%CI:69.48%~97.32%,P>0.05).The included literatures were found with no heterogeneity(OR=1.35>1)and no publication bias,and the results of sensitivity analysis were reliable.Conclusion Constrained fixation and unconstrained fixation of the anterior cervical plate are not significantly different in promoting bone graft fusion and improving early postoperative fusion rate.
引文
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[11]徐广辉,贾连顺.颈前路减压融合术后植骨融合的影像学评价方法及标准[J].中华外科杂志,2009,47(23):1824-1826.DOI:10.3760/cma.j.issn.0529-5815.2009.23.018.
[12]Dersimonian R,Nan L.Meta-analysis in clinical trials[J].Controlled Clinical Trials,1986,7(3):177-188.
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[16]邓可刚.循证医学证据的检索与利用[M].北京:人民卫生出版社,2008(S1).
[17]Pitzen TR,Chrobok J,Stulik J,et al.Implant complications,fusion,loss of lordosis,and outcome after anterior cervical plating with dynamic or rigid plates:Two-year results of a multi-centric,randomized,controlled study[J].Spine(Phila Pa 1976),2009,34(7):641-646.DOI:10.1097/BRS.0b013e318198ce10.
[18]江立波,薛恩兴,吴瑞凯,等.老年颈椎病患者颈前路次全切应用限制性与非限制性钛板的疗效对比[J].中华老年医学杂志,2013,32(8):857-860.DOI:10.3760/cma.j.issn.0254-9026.2013.08.017.
[19]Oh K,Lee CK,You NK,et al.Radiologic changes of anterior cervical discectomy and fusion using allograft and plate augmentation:Comparison of using fixed and variable type screw[J].Korean J Spine,2013,10(3):160-164.DOI:10.14245/kjs.2013.10.3.160.
[20]阮狄克,何勍,李超,等.限制性与非限制性滑动钛板在颈椎前路手术中的应用[J].中国脊柱脊髓杂志,2006,16(10):735-739.DOI:10.3969/j.issn.1004-406X.2006.10.004.
[21]Epstein NE.Fixed vs dynamic plate complications following multilevel anterior cervical corpectomy and fusion with posterior stabilization[J].Spinal Cord,2003,41(7):379-384.DOI:10.1038/sj.sc.3101447.
[22]Goldberg G,Albert TJ,Vaccaro AR,et al.Short-term comparison of cervical fusion with static and dynamic plating using computerized motion analysis[J].Spine(Phila Pa 1976),2007,32(13):E371-375.DOI:10.1097/BRS.0b013e318060cca9.
[23]杨杰,贾长青,刘瑞端,等.一期后路复位前路融合治疗下颈椎创伤性关节突交锁[J].中国骨与关节损伤杂志,2011,26(1):47-48.
[24]Phillips FM,Carlson G,Emery SE,et al.Anterior cervical pseudarthrosis.Natural history and treatment[J].Spine(Phila Pa 1976),1997,22(14):1585-1589.DOI:10.1097/00007632-199707150-00012.
[25]胡侦明.骨小梁的改建[J].国际骨科学杂志,1996(3):162-164.
[26]曾岩,党耕町,马庆军.颈椎前路融合术后假关节形成对疗效的影响[C].全国中青年颈椎病专题论坛,2007.
[27]Wang HS,Kim HY,Kim SW,et al.Advantages of the plating for anterior cervical discectomy and fusion:Comparison with wearing cervical collar without plate[J].Korean J Spine,2011,8(3):161-164.DOI:10.14245/kjs.2011.8.3.161.
[28]陈孝平,汪建平.外科学[M].8版.北京:人民卫生出版社,2013.
[2]Haid RW,Foley KT,Rodts GE,et al.The Cervical Spine Study Group anterior cervical plate nomenclature[J].Neurosurg Focus,2002,12(1):E15.DOI:10.3171/foc.2002.12.1.16.
[3]Reidy D,Finkelstein J,Nagpurkar A,et al.Cervical spine loading characteristics in a cadaveric C5 corpectomy model using a static and dynamic plate[J].J Spinal Disord Tech,2004,17(2):117-122.DOI:10.1097/00024720-200404000-00008.
[4]Brodke DS,Gollogly S,Alexander Mohr R,et al.Dynamic cervical plates:Biomechanical evaluation of load sharing and stiffness[J].Spine(Phila Pa 1976),2001,26(12):1324-1329.DOI:10.1097/00007632-200106150-00010.
[5]Brodke DS,Klimo P Jr,Bachus KN,et al.Anterior cervical fixation:Analysis of load-sharing and stability with use of static and dynamic plates[J].J Bone Joint Surg Am,2006,88(7):1566-1573.DOI:10.2106/JBJS.E.00305.
[6]Du Bois CM,Bolt PM,Todd AG,et al.Static versus dynamic plating for multilevel anterior cervical discectomy and fusion[J].Spine J,2007,7(2):188-193.DOI:10.1016/j.spinee.2006.07.004.
[7]Nunley PD,Jawahar A,Kerr EJ 3rd,et al.Choice of plate may affect outcomes for single versus multilevel ACDF:Results of a prospective randomized single-blind trial[J].Spine J,2009,9(2):121-127.DOI:10.1016/j.spinee.2007.11.009.
[8]陈涛,刘伟强,史长虹,等.颈椎前路内固定钢板系统的结构分析与应用[J].中国医疗器械杂志,2004(2):128-132.DOI:10.3969/j.issn.1671-7104.2004.02.015.
[9]李超,阮狄克,谈诚,等.垂直负荷下颈椎前路限制性与非限制性钢板的生物力学比较[J].第二军医大学学报,2005,26(12):1388-1391.DOI:10.3321/j.issn:0258-879X.2005.12.017.
[10]Lawrence BD,Patel AA,Guss A,et al.Malaligned dynamic anterior cervical plate:A biomechanical analysis of effectiveness[J].Spine(Phila Pa 1976),2014,39(25):2057-2061.DOI:10.1097/BRS.0000000000000630.
[11]徐广辉,贾连顺.颈前路减压融合术后植骨融合的影像学评价方法及标准[J].中华外科杂志,2009,47(23):1824-1826.DOI:10.3760/cma.j.issn.0529-5815.2009.23.018.
[12]Dersimonian R,Nan L.Meta-analysis in clinical trials[J].Controlled Clinical Trials,1986,7(3):177-188.
[13]Mantel N,Haenszel W.Statistical aspects of the analysis of data from retrospective studies of disease[J].J Natl Cancer Inst,1959,22(4):719-748.PMID:13655060.
[14]Begg CB,Mazumdar M.Operating characteristics of a rank correlation test for publication bias[J].Biometrics,1994,50(4):1088-1101.PMID:7786990.
[15]Egger M,Davey Smith G,Schneider M,et al.Bias in meta-analysis detected by a simple,graphical test[J].BMJ,1997,315(7109):629-634.PMID:9310563.
[16]邓可刚.循证医学证据的检索与利用[M].北京:人民卫生出版社,2008(S1).
[17]Pitzen TR,Chrobok J,Stulik J,et al.Implant complications,fusion,loss of lordosis,and outcome after anterior cervical plating with dynamic or rigid plates:Two-year results of a multi-centric,randomized,controlled study[J].Spine(Phila Pa 1976),2009,34(7):641-646.DOI:10.1097/BRS.0b013e318198ce10.
[18]江立波,薛恩兴,吴瑞凯,等.老年颈椎病患者颈前路次全切应用限制性与非限制性钛板的疗效对比[J].中华老年医学杂志,2013,32(8):857-860.DOI:10.3760/cma.j.issn.0254-9026.2013.08.017.
[19]Oh K,Lee CK,You NK,et al.Radiologic changes of anterior cervical discectomy and fusion using allograft and plate augmentation:Comparison of using fixed and variable type screw[J].Korean J Spine,2013,10(3):160-164.DOI:10.14245/kjs.2013.10.3.160.
[20]阮狄克,何勍,李超,等.限制性与非限制性滑动钛板在颈椎前路手术中的应用[J].中国脊柱脊髓杂志,2006,16(10):735-739.DOI:10.3969/j.issn.1004-406X.2006.10.004.
[21]Epstein NE.Fixed vs dynamic plate complications following multilevel anterior cervical corpectomy and fusion with posterior stabilization[J].Spinal Cord,2003,41(7):379-384.DOI:10.1038/sj.sc.3101447.
[22]Goldberg G,Albert TJ,Vaccaro AR,et al.Short-term comparison of cervical fusion with static and dynamic plating using computerized motion analysis[J].Spine(Phila Pa 1976),2007,32(13):E371-375.DOI:10.1097/BRS.0b013e318060cca9.
[23]杨杰,贾长青,刘瑞端,等.一期后路复位前路融合治疗下颈椎创伤性关节突交锁[J].中国骨与关节损伤杂志,2011,26(1):47-48.
[24]Phillips FM,Carlson G,Emery SE,et al.Anterior cervical pseudarthrosis.Natural history and treatment[J].Spine(Phila Pa 1976),1997,22(14):1585-1589.DOI:10.1097/00007632-199707150-00012.
[25]胡侦明.骨小梁的改建[J].国际骨科学杂志,1996(3):162-164.
[26]曾岩,党耕町,马庆军.颈椎前路融合术后假关节形成对疗效的影响[C].全国中青年颈椎病专题论坛,2007.
[27]Wang HS,Kim HY,Kim SW,et al.Advantages of the plating for anterior cervical discectomy and fusion:Comparison with wearing cervical collar without plate[J].Korean J Spine,2011,8(3):161-164.DOI:10.14245/kjs.2011.8.3.161.
[28]陈孝平,汪建平.外科学[M].8版.北京:人民卫生出版社,2013.