钛笼与聚醚醚酮椎间融合器在颈前路减压椎间融合中的应用

Application of titanium cages and poly(ether-ether-ketone) cages in anterior cervical discectomy and fusion surgery

背景:目前颈椎前路手术常用的两种椎间融合器为钛笼和聚醚醚酮椎间融合器,但两者在影像学及临床疗效评价上仍然存在争议。目的:系统评价钛笼与聚醚醚酮椎间融合器应用于颈前路减压椎间融合后影像学及临床疗效。方法:计算机检索Cochrane Library(2013年第5期)、MEDLINE、EMBASE、CNKI、万方数据库,收集至2013年6月1日国内外公开发表的在颈前路手术中对钛笼与聚醚醚酮椎间融合器的使用进行比较的对照研究,由2位研究者独立评价文献,采用Cochrane协作网提供的RevMan 5.2软件进行Meta分析。结果与结论:最终纳入文献4篇,共235例患者,其中钛笼组128例,聚醚醚酮椎间融合器组107例。Meta分析结果示:在融合率方面及临床疗效方面,两组差异无显著性意义(P>0.05),在融合器下沉移位率方面,两组在短期差异无显著性意义(P>0.05),但是在长期方面聚醚醚酮组下沉移位率要小于钛笼组,差异具有显著性意义(P<0.05)。在颈椎曲度和椎间隙高度的维持方面,聚醚醚酮组要优于钛笼组。在颈前路减压椎间融合术中应用聚醚醚酮椎间融合器可以获得较好的融合率和临床疗效,相比钛笼可以更好的长期维持颈椎曲度和椎间隙高度,并且拥有更小的下沉移位率。

BACKGROUND： The two main cages used in anterior cervical surgery are titanium cages and poly（ether-ether-ketone） cages, but it is still controversial in imaging performances and clinical outcomes. OBJECTIVE： To systematically evaluate imaging performances and clinical outcomes between titanium cages and poly（ether-ether-ketone） cages in anterior cervical discectomy and fusion surgery. METHODS： The Cochrane library （issue 5, 2013）, Medline database, EMBASE, CNKI and Wanfang database were retrieved by computer. The deadline of all the retrieves concerning control study of uses of titanium cages and poly（ether-ether-ketone） cages was June 1st, 2013. Two reviewers assessed literatures independently, and the meta-analysis was conducted by RevMan 5.2 software. RESULTS AND CONCLUSION： A total of four literatures including 235 patients, 128 of titanium cages and 107 of poly（ether-ether-ketone） cages, were included. Meta-analysis results showed that there was no statistically significant difference between the groups in fusion rates, subsidence and dislocation rates of short-term follow-up and clinical outcomes （all P 〉 0.05）. There were statistically significant differences between the groups in subsidence and dislocation rates of long-term follow-up （P 〈 0.05）. Poly（ether-ether-ketone） cage group was superior to titanium cages group in maintenance of cervical curvature and intervertebral height. This meta-analysis showed that poly（ether-ether-ketone） cages had good fusion rates and clinical outcomes, less subsidence and dislocation rates, and can better maintain cervical curvature and intervertebral height compared with titanium cages.