醫病共享決策輔助工具

跳過此工具列
字級:
小字級
中字級
大字級
:::

頸部椎間盤疾病 面臨 開刀時:我該選擇椎間盤融合術或人工椎間盤置換術?

科別 神經內外科
主題類別 神經系統及感官器官
決策類型 治療
關鍵字 人工椎間盤置換術(Total Disc Replacement*、Artificial Disk Replacement*、Total Disc Arthroplast*)、骨融合術(spinal fusion*)
適用病人條件 經醫師診斷頸椎椎間盤疾病患者,採取物理治療(復健)或藥物治療後,均無法改善症狀而需手術治療者
可供選擇決策方案 一、 椎間盤切除及椎間盤融合術,二、 椎間盤切除及人工椎間盤置換術
使用場所 診間、病房
執行者 醫師
開發團隊、機構 奇美醫療財團法人佳里奇美醫院
輔助工具研發過程說明

經醫師診斷頸椎椎間盤疾患,採取物理或藥物治療後均無法改善神經學症狀,代表病患需要考慮手術才能改善手麻、肌肉無力、頭暈等臨床表徵,其中手術方式選擇有(一)椎間盤融合術、(二)人工椎間盤置換術,然而因患者不了解何種術式適合自己,因此每位個案都需耗費長時間的解說,以及多次門診的溝通來做選擇,故希望藉由本PDA降低門診解釋時間,並協助病患更充分了解手術及一同決策手術方式。

參考文獻

Findlay, C., Ayis, S., & Demetriades, A. K. (2018). Total disc replacement versus anterior cervical discectomy and fusion: a systematic review with meta-analysis of data from a total of 3160 patients across 14 randomized controlled trials with both short- and medium- to long-term outcomes. Bone Joint J, 100-b(8), 991-1001. doi:10.1302/0301-620x.100b8.Bjj-2018-0120.R1
Li, Y., Shen, H., Khan, K. Z., Fang, S., Liao, Z., & Liu, W. (2018). Comparison of Multilevel Cervical Disc Replacement and Multilevel Anterior Discectomy and Fusion: A Systematic Review of Biomechanical and Clinical Evidence. World Neurosurg, 116, 94-104. doi:10.1016/j.wneu.2018.05.012
Lu, H., & Peng, L. (2017). Efficacy and safety of Mobi-C cervical artificial disc versus anterior discectomy and fusion in patients with symptomatic degenerative disc disease: A meta-analysis. Medicine (Baltimore), 96(49), e8504. doi:10.1097/md.0000000000008504
series, H. Q. O. J. O. h. t. a. (2019). Cervical Artificial Disc Replacement Versus Fusion for Cervical Degenerative Disc Disease: A Health Technology Assessment. 19(3), 1.
Xu, S., Liang, Y., Zhu, Z., Qian, Y., & Liu, H. (2018). Adjacent segment degeneration or disease after cervical total disc replacement: a meta-analysis of randomized controlled trials. J Orthop Surg Res, 13(1), 244. doi:10.1186/s13018-018-0940-9
Zhang, Y., Liang, C., Tao, Y., Zhou, X., Li, H., Li, F., & Chen, Q. J. P. O. (2015). Cervical total disc replacement is superior to anterior cervical decompression and fusion: a meta-analysis of prospective randomized controlled trials. 10(3), e0117826.
Zhao, H., Duan, L. J., Gao, Y. S., Yang, Y. D., Tang, X. S., Zhao, D. Y., . . . Yu, X. (2018). What is the superior surgical strategy for bi-level cervical spondylosis-anterior cervical disc replacement or anterior cervical decompression and fusion?: A meta-analysis from 11 studies. Medicine (Baltimore), 97(13), e0005. doi:10.1097/md.0000000000010005

版本 2019