人工全椎間盤置換治療退行性腰椎間盤疾病的系統評價_《中國循證醫學雜志》

作者：

何祖勝 ¹ , 白靖平 ² , 錫林寶勒日 ³ , 金格勒 ⁴ , 吳泰相 ⁵ , 李靜 ⁵

1. 新疆醫科大學,烏魯木齊,8300542. 新疆醫科大學第三附屬醫院,烏魯木齊,8300113. 新疆醫科大學第二附屬醫院,烏魯木齊,8300284. 新疆醫科大學第―附屬醫院,烏魯木齊,8300545. 四川大學華西醫院循證醫學與臨床流行病學中心,成都,610041;

關鍵詞：

人工椎間盤腰椎間盤疾病,退行性治療系統評價

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目的　分析人工全椎間盤置換治療退行性腰椎間盤疾病的療效.
方法　計算機檢索Cochrane圖書館(2004年第2期)中的臨床對照試驗資料庫和Cochrane協作網背痛專業試驗數據庫、MEDLINE(1966～2004)、EMBASE(1980～2004)、中國生物醫學文獻光盤數據庫(CBMdisk,2003),手工檢索中文文獻(截自2004年6月),并詢問相關廠家以及研究者.由兩名評價員獨立提取資料,并按Cochrane協作網提供的方法對納入文獻進行質量評價和結果分析.
結果　共納入3個RCT,包括152例患者.文獻質量評價結果顯示,3個RCT均可能存在選擇性偏倚、實施偏倚和測量偏倚的高度可能性.其中兩篇使用ProDisc-Ⅱ人工全椎間盤置換,1篇使用SB-Ⅲ人工全椎間盤置換.3個RCT均未提供詳細的原始數據,因此不能進行Meta分析.人工全椎間盤置換組病人術后早期VAS疼痛評分(visual analog scale)和ODI功能評分(oswestry disability index)有改善,但術后6個月與融合組無差異.病人滿意率,術后6個月人工全椎間盤置換組有優于融合組的趨勢.短期隨訪顯示,人工椎間盤能夠保存受累節段的運動功能.兩篇RCT報告了相關并發癥.
結論　人工全椎間盤置換短期內能夠重建退變節段的高度及生理運動功能,但缺乏長期的隨訪,尤其對于能否防止毗鄰節段的退變缺乏證據.尚需更多設計嚴格的研究以增加證據的強度.

引用本文： 何祖勝,白靖平,錫林寶勒日,金格勒,吳泰相,李靜. 人工全椎間盤置換治療退行性腰椎間盤疾病的系統評價. 中國循證醫學雜志, 2005, 05(2): 136-139. doi: 復制

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13.	McCullen GM, Yuan HA. Artificial disc: current developments in artificial disc replacement[J]. Current Opinion in Orthopaedics, 2003;14(3): 138-143.
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15.	McAfee PC, Fedder IL, Saiedy S, Shucosky EM, Cunningham BW. SB-Charité Disc Replacement: Report of 60 Prospective Randomized Cases in a U.S. Center[J]. J Spinal Disord Tech J Spinal Disord Tech, 2003;16(4): 424-433.

1. Folman Y, Lee SH, Silivera JR, Gepstein R. Posterior lumbar interbody fusion for degenerative disc disease using a minimaly invasive B-Twin expandable spinal spacer: a multicenter study[J]. Spinal Disorder&techniques, 2003;16(5): 455-460.
2. Chedid KJ, Chedid MK. The "tract" of history in the treatment of lumbar degenerative disc disease[J]. Neurosurg Focus, 2003;16(1): 1-4.
3. Hall BB, Asher MA, Zang RH, Quinn LM. The safety and efficacy of the isola spinal implant system for the surgical treatment of degenerative disc disease: d prospective study[J]. Spine, 1996;21(8): 982-994.
4. Jack EZ, Paul AA, Scott DB, Keith HB, Alexander RV. What is New in Spine Surgery in Spine Surgery[J]. The Journal Of Bone And Joint Surgery, 2003;85(8): 1 626-1 636.
5. Herkowitz HN, Abraham DJ, Albert TJ. Management of degenerative disc disease above an L5-S1 segment requiring arthrodesis [Controversy] [J]. Spine, 1999;24(12): 1 268.
6. QI BB, Hansen AY. Artificial disc technology[J]. Neurosurg Focus, 2000;9(4): 1-7.
7. Fritzell P, Hagg O, Wessberg P, Nordwall A .Lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group[J]. Spine, 2001;26(23): 2 521-2 534.
8. Resnick DK. Spinal Fusion for Discogenic Back Pain: Patient Selection, Operative Techniques, and Outcomes[J]. Techniques in Neurosurgery, 2003;8(3): 176-190.
9. Heary, Robert F. Intradiscal Electrothermal Annuloplasty: The IDET Procedure[J]. Journal of Spinal Disorders, 2001;14(4): 353-360.
10. Delamarter RB, Fribourg DM, Kanim LE, Bae H. ProDisc Artificial Total Lumbar Disc Replacement: Introduction and Early Results From the United States Clinical Trial[J]. Spine, 2003;28(20s): s167-s175.
11. Zigler JE. Clinical Results with ProDisc: European Experience and U.S. Investigation Device Exemption Study[J]. Spine, 2003;28(20s): s163-s166.
12. Cunningham BW, Gordon JD, Dmitriev AE, Hu NB, McAfee PC. Biomechanical Evaluation of Total Disc Replacement Arthroplasty: An In Vitro Human Cadaveric Model[J]. Spine, 2003;28(20s): s110-s117.
13. McCullen GM, Yuan HA. Artificial disc: current developments in artificial disc replacement[J]. Current Opinion in Orthopaedics, 2003;14(3): 138-143.
14. Juni P, Altman DG, Egger M. Assessing the quality of controlled clinical trials[J]. BMJ, 2001;323(7 303): 42-46.
15. McAfee PC, Fedder IL, Saiedy S, Shucosky EM, Cunningham BW. SB-Charité Disc Replacement: Report of 60 Prospective Randomized Cases in a U.S. Center[J]. J Spinal Disord Tech J Spinal Disord Tech, 2003;16(4): 424-433.

《中國循證醫學雜志》

人工全椎間盤置換治療退行性腰椎間盤疾病的系統評價

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《中國循證醫學雜志》

人工全椎間盤置換治療退行性腰椎間盤疾病的系統評價

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

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