CT、三维及二维导航系统辅助椎弓根置钉的Meta分析

The comparison of three navigation systems(CT, 2D and 3D)for auxiliary pedicle screw: a meta-analysis

目的系统评价CT、三维(3D)、二维(2D)导航系统辅助置钉的精确度。方法通过检索中英文数据库,对文献中椎弓根置钉精确度数据进行系统评价。结果检索后共得到597篇文献,最后有7篇文献纳入该Meta分析,7篇文献队列研究的质量评分均大于5分,满足系统评价所需的质量条件。使用0级标准时(螺钉侵犯椎弓根皮质≤0 mm),3D组的置钉精确度优于CT组,差异有统计学意义(OR=0.74,95%CI:0.57~0.97,P=0.03);使用临床可接受标准时(螺钉侵犯椎弓根皮质<2 mm),3D组的置钉精确度仍优于CT组(OR=0.48,95%CI:0.30~0.78,P<0.05)。在CT、3D、2D三组平行对照中,3D组与CT组比较,差异无统计学意义(OR=0.19,95%CI:0.02~1.65,P=0.13)。使用0级标准时,3D组置钉精确度明显高于2D组,差异有统计学意义(OR=5.40,95%CI:2.81~10.35,P<0.05)。使用临床可接受标准及平行对照时,3D组置钉精确度仍优于2D组(OR=4.87,95%CI:2.04~11.62,P<0.05;OR=9.77,95%CI:1.81~52.79,P<0.05)。结论 3D导航在提高螺钉置入精确度上优于CT导航和2D导航系统,可作为临床首选。

Objective To systematically evaluate the accuracy of CT, 3D and 2D navigation in auxiliary pedicle screw.Methods Several studies were searched in the Chinese and English data base, statistical analysis of the accuracy of pedicle screw placement were conducted. Results A total of 597 studies were screened finally, 7 papers were included in the Meta analysis, the quality scores of the 7 literature cohort studies were greater than 5 points, which met the quality requirements for systematic reviews. Under the 0 standard(screws invading the pedicle cortex less than 0 mm), the nail fixation accuracy of 3D was better than that of CT, the difference was statistically significant(OR=0.74, 95%CI: 0.57-0.97, P=0.03); under clinical acceptable standards(screws invading the pedicle cortex less than 2 mm), the nail fixation accuracy of 3D was better than that of CT(OR=0.48, 95%CI: 0.30-0.78, P<0.05); in parallel control of CT, 3D and 2D, the differences in 3D and CT were not statistically significant(OR=0.19, 95%CI: 0.02-1.65, P=0.13). Under the 0 standard, the nail fixation accuracy of 3D was higher than that of 2D(OR=5.40, 95%CI: 2.81-10.35, P<0.05), under clinical acceptable standards and in parallel control, the nail fixation accuracy of 3D was also better than that of 2D(OR=4.87, 95%CI: 2.04-11.62, P<0.05; OR=9.77, 95%CI: 1.81-52.79, P<0.05). Conclusion 3D navigation system is superior to CT and 2D in the accuracy of pedicle screw placemen, it can be used as the first choice in clinical practice