枕骨大孔减压术与减压联合脊髓空洞分流术治疗Arnold-Chiari畸形Ⅰ型合并脊髓空洞症的Meta分析

doi:10.3969/j.issn.1005-6483.2021.01.015

摘要/Abstract

摘要： 目的应用系统评价方法，分析枕骨大孔减压(FMD)与枕骨大孔减压联合脊髓空洞分流术(FMD+SSS)治疗Arnold-Chiari畸形Ⅰ型合并脊髓空洞症治疗效果的差异。
方法全面检索国内外关于FMD术与FMD+SSS术治疗Arnold-Chiari畸形Ⅰ型合并脊髓空洞症的随机、非随机对照试验，同时进行严格的质量评价，利用EndNoteX5、RevMan5.1、SPSS 16.0软件对纳入研究结果进行Meta分析。
结果共纳入8个研究符合标准(英文6篇、中文2篇)，共计441例被纳入分析。Meta分析结果显示，FMD与FMD+SSS比较术后并发症发生率、手术成功率、术后复发率、术后疼痛症状改善情况、术后运动、神经营养障碍改善情况以及术后MRI观察空洞减小程度的差异均无显著性意义(P>0.05)；术后感觉障碍的改善情况单纯FMD组优于FMD+SSS组［OR合并=8.24，95%CI为1.88～36.06，Z=2.80(P=0.005)］，采用Bonferroni法进行多重假设检验校正结果α＇=0.017、二者之间比较0.017>0.05,差异有统计学意义。
结论 FMD与FMD+SSS治疗Arnold-Chiari畸形Ⅰ型均可达到满意的治疗效果，但相比较而言单纯FMD术后感觉障碍的改善方面更具优势。

关键词: Chiari畸形, 枕骨大孔减压, 脊髓空洞分流, Meta分析, 系统评价, 非随机对照试验

Abstract: Objective Application system evaluation method to analyse foramen magnum decompression(FMD) and foramen magnum decompression combined with Syringo-subarachnoid Shunting(FMD+SSS) treatment of Arnold-Chiari malformation type1merger syringomyelia differences in therapeutic effect.
Methods We searched the documents about the foramen magnum decompression associated with foramen magnum decompression combined with Syringo-subarachnoid Shunting Arnold-Chiari malformation type1combined treatment of syringomyelia randomized,non-randomized controlled trial,strict quality assessment at the same time,the use of EndNoteX5,RevMan5.1,SPSS16.0 software for Meta-analysis included in the results of the study.
Results The results were incorporated into eight study accord with a standard(six in English and two in Chinese),a total of 441 were included in the analysis,Meta-analysis showed:the foramen magnum decompression comparative with foramen magnum decompression combined with syringo-subarachnoid shunting incidence of postoperative complications,surgical success rate,postoperative recurrence,postoperative pain symptoms improve the situation,improve postoperative movement,nerve nutritional disorders,and postoperative MRI observation hole there was no significant difference were syrinx in the reduced degree(P>0.05).Improve postoperative sensory disorder of simple decompression group is better than that of decompression + shunt group[ORmerge=8.24,95%CI:1.88～36.06,Z=2.80(P=0.005)],using the Bonferroni method to carry on the multiple hypothesis testing calibration results α＇=0.017,comparison between 0.017>0.005 had significant statistical significance.
Conclusion FMD and FMD+SSS treatment of Arnold-Chiari malformation type1 can achieve satisfactory therapeutic effect,but in comparison,simple foramen magnum 〖LM〗decompression improved postoperative sensory disorder has more advantages.

Key words: Chiari malformation, foramen magnum decompression, syringo-subarachnoid shunting, Meta-analysis, systematic review, non-randomized controlled trial

马军孙崇毅张建楠. 枕骨大孔减压术与减压联合脊髓空洞分流术治疗Arnold-Chiari畸形Ⅰ型合并脊髓空洞症的Meta分析[J]. 临床外科杂志, 2021, 29(1): 45-48.

MA Jun, SUN Chongyi, ZHANG Jiannan. Foramen magnum decompression and it combined with decompression syringomyelia shunt in treatment of Arnold-Chiari malformation typeⅠ merger syringomyelia：Meta-analysis[J]. JOURNAL OF CLINICAL SURGERY, 2021, 29(1): 45-48.

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