ACDF与PCDF与椎板成形术治疗多节段脊髓型颈椎病：系统评价与荟萃分析。

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中文摘要

研究设计： 系统评价与荟萃分析。
目的： 比较ACDF、PCDF和椎板成形术治疗多节段脊髓型颈椎病（CSM）的功能、影像学和并发症结局。
背景资料摘要： CSM是美国患者发病和死亡的重要原因。针对这种退行性病变，通常采用三种手术入路：ACDF、PCDF和椎板成形术。需要比较数据来指导入路选择。
方法： 按照PRISMA指南，检索PubMed、Embase、CENTRAL和Scopus截至2026年2月，以识别报告成人多节段（≥3个节段）CSM患者接受ACDF、PCDF或椎板成形术结局的比较研究。12项研究共1,129例患者符合纳入标准，并组织为三组两两比较：ACDF与椎板成形术、PCDF与椎板成形术、ACDF与PCDF。对功能、影像学和并发症结局进行比较评估。连续结局合并为均数差（MD）及95%置信区间（CI）。二分类结局合并为比值比（OR）及95%CI。使用I²统计量评估异质性。
结果： ACDF与椎板成形术之间（MD=-0.20，P=0.43）或ACDF与PCDF之间（MD=1.06，P=0.21）的JOA评分改善无差异。颈部疼痛VAS评分支持ACDF优于椎板成形术（MD=-1.05，P=0.03）。与椎板成形术相比，ACDF显示颈椎活动度降低（MD=-9.14°，P<0.001）。相对于椎板成形术，ACDF后住院时间更短（MD=-2.62天，P=0.002），而PCDF后更长（MD=1.19天，P<0.001）。与椎板成形术相比，ACDF与较低的轴性疼痛发生率（Peto OR=0.21，P=0.007）和C5神经根麻痹发生率（Peto OR=0.27，P=0.049）相关，但吞咽困难发生率更高（Peto OR=5.88，P<0.001）。PCDF后SSI比椎板成形术更常见（Peto OR=4.27，P=0.01）。
结论： ACDF、PCDF和椎板成形术在多节段CSM中表现出相似的神经功能恢复。颈椎活动度、住院时间和并发症谱方面的术式特异性差异支持根据术前序列和患者特异性关注点指导入路选择。

英文摘要

STUDY DESIGN: Systematic review and meta-analysis.
OBJECTIVE: To compare functional, radiographic, and complication outcomes among ACDF, PCDF, and laminoplasty for multilevel cervical spondylotic myelopathy (CSM).
SUMMARY OF BACKGROUND DATA: CSM is a major source of patient morbidity in the United States. Three surgical approaches are commonly employed for this degeneration: ACDF, PCDF, and laminoplasty. Comparative data is warranted to guide approach selection.
METHODS: In accordance with PRISMA guidelines, PubMed, Embase, CENTRAL, and Scopus were searched through February 2026 to identify comparative studies reporting outcomes among adult patients undergoing ACDF, PCDF, or laminoplasty for multilevel (≥3 levels) CSM. Twelve studies comprising 1,129 patients met inclusion criteria and were organized into three pairwise comparisons: ACDF versus laminoplasty, PCDF versus laminoplasty, and ACDF versus PCDF. Functional, radiographic, and complication outcomes were comparatively assessed. Continuous outcomes were pooled as mean differences (MD) with 95% confidence intervals (CI). Dichotomous outcomes were pooled as odds ratios (OR) with 95% CI. Heterogeneity was assessed using the I² statistic.
RESULTS: JOA score improvement did not differ between ACDF and laminoplasty (MD=-0.20, P=0.43) or ACDF and PCDF (MD=1.06, P=0.21). VAS neck pain favored ACDF over laminoplasty (MD=-1.05, P=0.03). ACDF demonstrated reduced cervical range of motion (MD=-9.14°, P<0.001) compared with laminoplasty. Hospital stay was shorter after ACDF (MD=-2.62 days, P=0.002) and longer after PCDF (MD=1.19 days, P<0.001) relative to laminoplasty. ACDF was associated with lower rates of axial pain (Peto OR=0.21, P=0.007) and C5 palsy (Peto OR=0.27, P=0.049) but higher rates of dysphagia (Peto OR=5.88, P<0.001) compared with laminoplasty. SSI was more frequent after PCDF than laminoplasty (Peto OR=4.27, P=0.01).
CONCLUSIONS: ACDF, PCDF, and laminoplasty demonstrated similar neurological recovery for multilevel CSM. Procedure-specific differences in cervical range of motion, length of stay, and complication profiles support approach selection guided by preoperative alignment and patient-specific concerns.