钛金属cage与聚醚醚酮cage在颈前路减压融合术后临床疗效的Meta分析

Clinical effect of titanium cage versus polyetheretherketone cage after the anterior cervical decompression and fusion：a Meta-analysis

目的 采用Meta分析比较钛金属cage与聚醚醚酮（PEEK）cage在颈前路减压椎间融合术（ACDF）中的临床效果,为ACDF植入物的选择提供临床依据.方法 计算机检索PubMed数据库、Cochrane数据库、Embase数据库、中国知网数据库、万方数据库,并辅以手工检索,收集2007年1月—2017年3月有关钛金属cage和PEEK cage用于ACDF临床效果对照研究的中英文文献,按照Jadad量表严格评价纳入文献质量,并提取相关数据,运用Revman 5.0软件对所有相关数据进行分析.结果 纳入5项研究共361例患者,其中高质量文献4篇,中质量文献1篇.Meta分析显示对于ACDF,PEEK cage下沉发生率低于钛金属cage（OR=3.49,95%CI 1.75~6.99,P=0.0004）,而在融合率（OR=1.60,95%CI 0.05~53.73,P=0.79）、脱位发生率（OR=3.61,95%CI 0.91~14.34,P=0.07）、手术时间（WMD=0.87,95%CI-24.95~26.69,P=0.95）、Odom评分优良率（OR=0.89,95%CI 0.49~1.63,P=0.71）、NDI评分（WMD=3.24,95%CI-0.44~6.93,P=0.08）及手术节段术后Cobb角（WMD=-2.29,95%CI-4.63~0.05,P=0.05）等方面两种cage差异无统计学意义.结论 钛金属cage和PEEK cage应用于ACDF均能获得理想的临床效果,术后PEEK cage下沉发生率更低.

Objective This study was designed to analyze and compare the efficacy and outcomes of anterior cervical decompression and fusion （ ACDF） using polyetheretherketone （ PEEK） cages and titanium cage. Methods Reports of studies using case-control studies to compare the titanium cage and PEEK cage in ACDF were retrieved from the PubMed Library, Cochrane Library, Embase Library, China National Knowledge Internet and Wanfang Data from January 2007 to March 2017. Methodological quality of the studies was critically assessed. Statistical software Revman 5. 0 was used for data-analysis. Results A total of 5 studies involved 361 patients were included. Among them, 4 literatures were high quality, and 1 was medium. The results showed that, when the efficacy of PEEK cage and titanium cage were compared in ACDF, there was statistical difference in the subsidence rate [odds ratio（OR） =3. 49, 95%CI 1. 75 -6. 99, P=0. 0004]. However, there was no statistical significance in the fusion rate（OR=1. 60, 95%CI 0. 05-53. 73, P=0. 79）, dislocation rate（OR=3. 61, 95%CI 0. 91 -14. 34, P=0. 07）, the average operation time[weighted mean difference（WMD） =0. 87, 95%CI -24. 95 ~26. 69, P =0. 95], the excellent and good rate of Odom index （OR=1. 27, 95%CI 0. 60-2. 68, P=0. 71）, NDI（WMD=3. 24, 95%CI -0. 44-6. 93, P=0. 08）and Cobb angel of operated segment（WMD= -2. 29, 95%CI -4. 63-0. 05, P=0. 05）. Conclusions The PEEk cage is superior to the titanium cage in ACDF in regards to the subsidence rate, but both cages achieve similar and satisfactory clinical effect in the ACDF.