頸椎人工椎間盤置換術治療單節段頸椎病療效和安全性的系統評價_《中國循證醫學雜志》

作者：

江華 ,  肖增明 , 詹新立 , 李世德 , 勞山 , 李書振

廣西醫科大學第一附屬醫院脊柱骨病外科（南寧?530021）;

關鍵詞：

融合頸椎椎間盤置換關節成形術 Meta分析系統評價

DOI：

10.7507/1672-2531.20100526

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目的 ?系統評價頸椎人工椎間盤置換術（TDR）與頸前路減壓植骨融合術（ACDF）治療單節段頸椎病的療效和安全性。
方法 ?計算機檢索MEDLINE（2000.1～2009.5）、EMbase（2000.1～2009.5）、OVID（2000.1～2009.5）、Cochrane 圖書館對照試驗注冊庫（2009 年第1期）、中國生物醫學文獻數據庫（2000.1～2009.5）、CNKI（2000.1～2009.5），手工檢索《中華外科雜志》等6種相關雜志，納入TDR和ACDF比較治療單節段頸椎病的隨機對照試驗（RCT）。由2名評價者按納入排除標準選擇試驗，評價質量并交叉核對后，采用RevMan 5.0軟件進行Meta分析。
結果 ?共納入6篇RCT，包括1 340例患者。Meta分析結果顯示：TDR與ACDF兩組術后頸痛評分［MD= –0.90，95%CI（–1.18，–0.62）］、術后上肢痛評分［MD= –0.70，95%CI（–0.86，–0.54）］、術后神經功能滿意率［RR=1.06，95%CI（1.02，1.11），P=0.003］、再次手術發生率[RR=0.30，95%CI（0.17，0.53），P lt;0.000 1］和總體治愈率［RR=1.13，95%CI（1.06，1.22），P=0.000 6］的差異有統計學意義；而兩組術后頸部功能障礙指數評分［WMD=1.53，95%CI（–0.55，3.61），P=0.15]、術后影像學滿意率［RR=0.96，95%CI（0.92，1.01），P=0.11］和術后并發癥發生率［RR=0.79，95%CI（0.49，1.28），P=0.34］差異無統計學意義。
結論 ?TDR能緩解頸及上肢痛、改善神經功能、降低再次手術率，提高單節段頸椎病的總體治愈率，但在頸部功能改善、術后影像學評估及并發癥發生等方面，TDR和ACDF療效相似。

引用本文： 江華,肖增明,詹新立,李世德,勞山,李書振. 頸椎人工椎間盤置換術治療單節段頸椎病療效和安全性的系統評價. 中國循證醫學雜志, 2010, 10(8): 957-963. doi: 10.7507/1672-2531.20100526 復制

1.	Yue WM, Brodner W, Highland TR. Long-term results after anterior cervical discectomy and fusion with allograft and plating: a 5- to 11-year radiologic and clinical follow-up study. Spine, 2005, 30(19): 2138-2144.
2.	Fraser JF, Hartl R. Anterior approaches to fusion of the cervical spine:a meta-analysis of fusion rates. J Neurosurg Spine, 2007, 6(4): 298-303.
3.	Hilibrand AS, Carlson GD, Palumbo MA, et al. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am, 1999, 81(4): 519-528.
4.	Goffin J, Geusens E, Vantomme N, et al. Long-term follow-up after interbody fusion of the cervical pine. J Spinal Disord Tech, 2004, 17(2): 79-85.
5.	Park DK, An HS. Problems related to cervical fusion: malalignment and nonunion. Instr Course Lect, 2009, 58: 737-745.
6.	Sasso RC, Smucker JD, Hacker RJ, et al. Artificial disc versus fusion: a prospective, randomized study with 2-year follow-up on 99 patients. Spine, 2007, 15(12): 2933-2940.
7.	Pickett GE, Sekhon LH, Sears WR, et al. Complications with cervical arthroplasty. J Neurosurg Spine, 2006, 4(2): 98-105.
8.	Anderson PA, Sasso RC, Riew KD. Update on cervical artificial disk replacement. Instr Course Lect, 2007, 56: 237-245.
9.	Yoon DH, Yi S, Shin HC, et al. Clinical and radiological results following cervical arthroplasty. Acta Neurochir (Wien), 2006, 148(9): 943-950.
10.	Mummaneni PV, Burkus JK, Haid RW, et al. Clinical and radiographic analysis of cervical disc arthroplasty compared with allograft fusion: a randomized controlled clinical trial. J Neurosurg Spine, 2007, 6(3): 198-209.
11.	Riina J, Patel A, Dietz JW, et al. Comparison of single-level cervical fusion and a metal-on-metal cervical disc replacement device. Am J Orthop, 2008, 37(4): E71-E77.
12.	Murrey D, Janssen M, Delamarter R, et al. Results of the prospective, randomized, controlled multicenter Food and Drug Administration investigational device exemption study of the ProDisc-C total disc replacement versus anterior discectomy and fusion for the treatment of 1-level symptomatic cervical disc disease. Spine J, 2009, 9(4): 275-286.
13.	Heller JG, Sasso RC, Papadopoulos SM, et al. Comparison of BRYAN cervical disc arthroplasty with anterior cervical decompression and fusion: clinical and radiographic results of a randomized, controlled, clinical trial. Spine, 2009, 34(2): 101-107.
14.	王巖, 蔡斌, 張雪松, 等. Bryan人工頸椎間盤置換治療單節段頸椎病的前瞻性臨床研究. 中華外科雜志, 2008, 46(5): 328-332.
15.	Nabhan A, Steudel WI, Nabhan A, et al. Segmental kinematics and adjacent level degeneration following disc replacement versus fusion: RCT with three years of follow-up. J Long Term Eff Med Implants, 2007, 17(3): 229-236.
16.	Higgins JPT, Green S, editors. Assessing risk of bias in includeds tudies. Cochrane Handbook for Systematic Reviews of Interventions 5.0.0 [updated February 2008; Part 2 Chapter 8. In: The Cochrane Library, Issue 3, 2008. Chichester, UK: John Wiley & Sons, Ltd.
17.	吳泰相, 劉關鍵. 隱蔽分組（分配隱藏）和盲法的概念、實施與報告. 中國循證醫學雜志, 2007, 7(3): 222-225.
18.	Chang UK, Kim DH, Lee MC, et al. Changes in adjacent-level disc pressure and facet joint force after cervical disc arthroplasty compared with cervical discectomy and fusion. J Neurosurg Spine, 2007, 7(1): 33-39.
19.	Pickett GE, Rouleau JP, Duggal N. Kinematic analysis of the cervical spine following implantation of an artificial cervical disc. Spine, 2005, 30(17): 1949-1954.
20.	Dmitriev AE, Cunningham BW, Hu N, et al. Adjacent level intradiscal pressure and segmental kinematics following a cervical total disc arthroplasty: an invitro human cadaveric model. Spine, 2005, 30(10): 1165-1172.
21.	Rousseau MA, Cottin P, Levante S, et al. In vivo kinematics of two types of ball-and-socket cervical disc replacements in the sagittal plane: cranial versus caudal geometric center. Spine, 2008, 33(1): E6-E9.
22.	Rabin D, Pickett GE, Bisnaire L, et al. The kinematics of anterior cervical discectomy and fusion versus artificial cervical disc: a pilot study. Neurosurgery, 2007, 61(3 Suppl): 100-105, discussion 104-105.
23.	Chang UK, Kim DH, Lee MC, et al. Changes in adjacent-level discpressure and facet joint force after cervical arthroplasty compared with cervical discectomy and fusion. J Neurosurg Spine, 2007, 7(l): 33-39.

1. Yue WM, Brodner W, Highland TR. Long-term results after anterior cervical discectomy and fusion with allograft and plating: a 5- to 11-year radiologic and clinical follow-up study. Spine, 2005, 30(19): 2138-2144.
2. Fraser JF, Hartl R. Anterior approaches to fusion of the cervical spine:a meta-analysis of fusion rates. J Neurosurg Spine, 2007, 6(4): 298-303.
3. Hilibrand AS, Carlson GD, Palumbo MA, et al. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am, 1999, 81(4): 519-528.
4. Goffin J, Geusens E, Vantomme N, et al. Long-term follow-up after interbody fusion of the cervical pine. J Spinal Disord Tech, 2004, 17(2): 79-85.
5. Park DK, An HS. Problems related to cervical fusion: malalignment and nonunion. Instr Course Lect, 2009, 58: 737-745.
6. Sasso RC, Smucker JD, Hacker RJ, et al. Artificial disc versus fusion: a prospective, randomized study with 2-year follow-up on 99 patients. Spine, 2007, 15(12): 2933-2940.
7. Pickett GE, Sekhon LH, Sears WR, et al. Complications with cervical arthroplasty. J Neurosurg Spine, 2006, 4(2): 98-105.
8. Anderson PA, Sasso RC, Riew KD. Update on cervical artificial disk replacement. Instr Course Lect, 2007, 56: 237-245.
9. Yoon DH, Yi S, Shin HC, et al. Clinical and radiological results following cervical arthroplasty. Acta Neurochir (Wien), 2006, 148(9): 943-950.
10. Mummaneni PV, Burkus JK, Haid RW, et al. Clinical and radiographic analysis of cervical disc arthroplasty compared with allograft fusion: a randomized controlled clinical trial. J Neurosurg Spine, 2007, 6(3): 198-209.
11. Riina J, Patel A, Dietz JW, et al. Comparison of single-level cervical fusion and a metal-on-metal cervical disc replacement device. Am J Orthop, 2008, 37(4): E71-E77.
12. Murrey D, Janssen M, Delamarter R, et al. Results of the prospective, randomized, controlled multicenter Food and Drug Administration investigational device exemption study of the ProDisc-C total disc replacement versus anterior discectomy and fusion for the treatment of 1-level symptomatic cervical disc disease. Spine J, 2009, 9(4): 275-286.
13. Heller JG, Sasso RC, Papadopoulos SM, et al. Comparison of BRYAN cervical disc arthroplasty with anterior cervical decompression and fusion: clinical and radiographic results of a randomized, controlled, clinical trial. Spine, 2009, 34(2): 101-107.
14. 王巖, 蔡斌, 張雪松, 等. Bryan人工頸椎間盤置換治療單節段頸椎病的前瞻性臨床研究. 中華外科雜志, 2008, 46(5): 328-332.
15. Nabhan A, Steudel WI, Nabhan A, et al. Segmental kinematics and adjacent level degeneration following disc replacement versus fusion: RCT with three years of follow-up. J Long Term Eff Med Implants, 2007, 17(3): 229-236.
16. Higgins JPT, Green S, editors. Assessing risk of bias in includeds tudies. Cochrane Handbook for Systematic Reviews of Interventions 5.0.0 [updated February 2008; Part 2 Chapter 8. In: The Cochrane Library, Issue 3, 2008. Chichester, UK: John Wiley & Sons, Ltd.
17. 吳泰相, 劉關鍵. 隱蔽分組（分配隱藏）和盲法的概念、實施與報告. 中國循證醫學雜志, 2007, 7(3): 222-225.
18. Chang UK, Kim DH, Lee MC, et al. Changes in adjacent-level disc pressure and facet joint force after cervical disc arthroplasty compared with cervical discectomy and fusion. J Neurosurg Spine, 2007, 7(1): 33-39.
19. Pickett GE, Rouleau JP, Duggal N. Kinematic analysis of the cervical spine following implantation of an artificial cervical disc. Spine, 2005, 30(17): 1949-1954.
20. Dmitriev AE, Cunningham BW, Hu N, et al. Adjacent level intradiscal pressure and segmental kinematics following a cervical total disc arthroplasty: an invitro human cadaveric model. Spine, 2005, 30(10): 1165-1172.
21. Rousseau MA, Cottin P, Levante S, et al. In vivo kinematics of two types of ball-and-socket cervical disc replacements in the sagittal plane: cranial versus caudal geometric center. Spine, 2008, 33(1): E6-E9.
22. Rabin D, Pickett GE, Bisnaire L, et al. The kinematics of anterior cervical discectomy and fusion versus artificial cervical disc: a pilot study. Neurosurgery, 2007, 61(3 Suppl): 100-105, discussion 104-105.
23. Chang UK, Kim DH, Lee MC, et al. Changes in adjacent-level discpressure and facet joint force after cervical arthroplasty compared with cervical discectomy and fusion. J Neurosurg Spine, 2007, 7(l): 33-39.

《中國循證醫學雜志》

頸椎人工椎間盤置換術治療單節段頸椎病療效和安全性的系統評價

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《中國循證醫學雜志》

頸椎人工椎間盤置換術治療單節段頸椎病療效和安全性的系統評價

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