超声骨刀与传统椎板切开器械应用于脊柱后路手术的有效性与安全性的Meta分析

Meta-analysis of the Effectiveness and Safety of Ultrasonic Osteotome and Traditional Laminectomy in the Treatment of Posterior Spinal Surgery

目的:使用Meta分析方法评价超声骨刀与传统椎板切开器械(椎板咬骨钳、气动磨钻)在脊柱后路手术中的有效性与安全性。方法:以"超声骨刀""超声手术刀""超声刀""椎"为中文关键词,以"bone curette""cutter""scalpel""bone shaver""aspirator""osteotome""ultrasonic""piezosurgery""dent*"为英文检索词,在Pubmed(1966-2018.12),Cochrane Library,Embase(1986-2018.12)、中国生物医学文摘数据库(CBM,1978-2018.12)、中国期刊全文数据库(CNKI,1979-2018.12)、万方数据库(1998-2018.12)、维普数据库(VIP,1989-2018.12)中进行检索,搜集所有使用超声骨刀、气动磨钻和椎板咬骨钳的随机对照试验和队列研究。由2名研究者分别筛选文献并严格地进行数据提取和评价纳入研究质量。Meta分析采用Revman v5.3.5.0版本。结果:经过筛选,最终纳入3项随机对照试验和6项回顾性队列研究,共计548例患者。Meta分析结果显示:采用超声骨刀的试验组的单椎板切除时间(MD=3.20,95%CI(1.16,5.24),P<0.05)、单椎板出血量(MD=26.87,95%CI(11.96,41.77),P<0.01)明显低于采用传统器械(椎板咬骨钳、气动磨钻)的对照组;但术后JOA评分(MD=-0.13,95%CI(-0.33,0.06),P>0.05)以及并发症发生率(OR=1.57,95%CI(0.68,3.63),P>0.05)的差异无统计学意义。结论:根据既往研究数据,在脊柱后路手术中应用超声骨刀可有效缩短椎板切除时间并有利于止血,减少术中出血量,但在手术疗效、术后恢复、并发症发生率等方面没有显著差异。

Objective:To evaluate the effectiveness and safety of ultrasonic osteotome and traditional laminectomy instruments(high-speed-drill laminectomy punch)in posterior rspinal surgery.Methods:"Ultrasonic bone knife""ultrasonic scalpel""ultrasonic scalpel""vertebra"as Chinese keywords,"bone curette""cut""scalpel""bone shaver""aspirator""osteotome""ultrasonic""piezosurgery""dent*"are English search terms,in Pubmed(1966-2018.12),Cochrane Library,Embase(1986-2018.12),Chinese Biomedical Abstracts Database(CBM,1978-2018.12)Search in Chinese Journal Full-text Database(CNKI,1979-2018.12),Wanfang Database(1998-2018.12),and Weipu Database(VIP,1989-2018.12),collect all bone osteo synthesis,pneumatic grinding drill and laminar bone randomized controlled trials and cohort studies of forceps.Two investigators screened the literature separately and rigorously extracted the data and evaluated the quality of the included studies Meta analysis was performed using Revman v5.3.5.0.Results:Three randomized controlled trials and six cohort studies were included with a total of 548 patients.Meta-analysis results showed that the single lami ectomytime of the experimental group using the ultrasonic osteotome(MD=2.70,95%CI(0.32,5.09),P<0.05)single lamina rhemorrhage(MD=26.87,95%CI(11.96,41.77),P<0.01)was significantly lower than the control group using traditional instruments(laminarrongeur.pneumatic grinding);but post operative JOA score(MD=-0.13,95%CI(-0.33,0.06),P>0.05)and the complication rate(OR=1.57,95%CI(0.68,3.63),P>0.05)was not statistically significant.Conclusion:The available evidence indicates that the use of ultrasonic osteotome in posterior rspinal surgery can effectively shorten the time of laminectomy and reduce the amount of intraoperative blood loss,but there is no significant difference in surgical outcome postoperative recovery,and complication rate.