皮质骨轨迹螺钉与椎弓根螺钉在后路胸腰椎融合术应用的Meta分析

doi:10.3969/j.issn.1006-7795.2019.04.004

摘要/Abstract

摘要： 目的通过Meta分析来判断皮质骨轨迹螺钉皮质骨轨迹螺钉（cortical bone trajectory screw，CBT）与传统椎弓根螺钉（pedicle screw，PS）技术在后路胸腰椎手术中应用的优劣。方法通过Pubmed、万方数据库搜索了2019年2月前所有CBT与PS的比较研究。纳入标准：1）皮质骨轨迹螺钉与椎弓根螺钉在后入路胸腰椎融合术的对比研究；2）均采用徒手操作，不涉及特殊导航系统；3）后路开放手术。排除标准：1）前后路联合手术；2）使用了特殊导航系统；3）使用了经皮置钉的技术。提取数据并整理到Excel表格，使用Revman 5.3.5进行数据分析。分析对象包括是否融合、术中估计出血量、手术时间、住院时间、术后合并症、功能障碍指数（Oswestry Disability Index，ODI）评分。结果本次研究共纳入13篇文献，其中12篇英文文献，1篇中文文献，其中，随机对照试验（randomized controlled trial，RCT）2篇，其余为队列研究。共计纳入人数为855人。1）末次融合：无充分证据认为两者在融合方面存在差异。2）术中出血量：CBT术中出血量低于PS，差异有统计学意义。3）手术时间：在后路开放手术中，CBT的手术时间显著低于椎弓根螺钉，差异具有统计学意义。4）住院时间：相较于椎弓根螺钉手术，CBT手术住院时间较短且差异具有统计学意义。5）合并症：皮质骨轨迹螺钉手术总体合并症发生率较椎弓根螺钉更低，且差异具有统计学意义。尚无充分证据支持二者的术中硬膜漏发生率有差异。6）末次随访ODI评分：无充分理由支持皮质骨轨迹螺钉与椎弓根螺钉术后末次ODI评分有差异。结论皮质骨轨迹螺钉在术中估计出血量、合并症、手术时间、住院时间方面优于椎弓根螺钉，而在硬膜损伤、融合率、术后末次随访ODI评分方面尚无足够证据证实二者存在差异。

关键词: 皮质骨轨迹螺钉, 椎弓根螺钉, 椎体融合

Abstract: Objective To evaluate the application of cortical bone trajectory screw (CBT) and traditional pedicle screw (PS) in posterior thoracic and lumbar surgery with Meta analysis. Methods A comparative study of all CBT and PS before February 2019 was searched with Pubmed and Wanfang data. Inclusion criteria:1Comparative study of CBT and PS in posterior thoracic and lumbar fusion;2All of them were operated by hand and did not involve special navigation system;3Posterior open surgery. Exclusion criteria:1Combined anterior and posterior surgery;2A special navigation system was used;3A percutaneous nailing technique was used. The data were extracted and sorted with Excel software and Revman 5.3.5 was used for data analysis. The subjects included fusion, intraoperative estimated blood loss, volume, operation time, hospitalization time, postoperative complications, and Oswestry Disability Index (ODI) score. Results A total of 13 literatures including 12 English and 1 Chinese literatures were included in this study, with 2 randomized controlled trial (RCT) and the rest cohort studies. The total number of people included was 855. ①Last fusion:there was no good reason to believe that there was a difference in integration. ②The amount of intraoperative blood loss:the intraoperative bleeding of CBT was lower than that of PS, with significant difference. ③Operation time:in posterior open surgery, the operation time of CBT was significantly lower than that of PS, with statistically significant difference. ④Hospital stay:compared with PS surgery group, hospitalization time after CBT operation was shorter, with statistically significant difference. ⑤Concurrent development syndrome:the overall incidence of complications of CBT surgery was lower than that of PS, with statistical significance. However, there was no good reason to support the difference in the incidence of intraoperative dural leakage between the two groups. ⑥The ODI score of the last follow-up:there was no good reason to support the difference between CBT and PS in the last ODI score after operation. Conclusion The results of this study show that CBT is superior to PS in evaluating blood loss, complications, operation time and hospitalization time during operation, but in dural injury and fusion rate, there was no sufficient reason to confirm the difference in ODI score after the last follow-up.

Key words: cortical bone trajectory screw, pedicle screw, vertebral fusion

中图分类号:

R681.5⁺3

张天擎, 张希诺, 韩渤, 李越, 潘爱星, 刘铁, 海涌, 关立, 刘玉增. 皮质骨轨迹螺钉与椎弓根螺钉在后路胸腰椎融合术应用的Meta分析[J]. 首都医科大学学报, 2019, 40(4): 510-516.

Zhang Tianqing, Zhang Xino, Han Bo, Li Yue, Pan Aixing, Liu Tie, Hai Yong, Guan Li, Liu Yuzeng. Meta analysis of cortical bone trajectory screw and pedicle screw in posterior thoracic and lumbar fusion[J]. Journal of Capital Medical University, 2019, 40(4): 510-516.

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