后路腰椎椎间融合中应用皮质骨螺钉与椎弓根螺钉疗效比较的Meta分析

Comparative clinical efficacy of cortical bone trajectory screw and pedicle screw fixation in posterior lumbar interbody fusion:a meta‑analysis

背景:椎弓根螺钉固定目前广泛应用于后路腰椎椎间融合术,但由于其具有广泛肌肉剥离、侵犯邻近关节等缺点,2009年开始应用皮质骨螺钉行后路腰椎椎间融合术以减少术中出血量及并发症。目前已有的比较皮质骨螺钉与椎弓根螺钉在后路腰椎椎间融合术的临床疗效Meta分析存在纳入文献术式不统一、随访时间较短和研究数量较少等缺陷。目的:观察后路腰椎椎间融合中应用皮质骨螺钉与椎弓根螺钉的疗效比较差异。方法:运用计算机检索2009年1月至2020年1月1日PubMed、Embase、Web of Science、中国生物医学文献服务系统、知网、万方数据库,搜索关于应用皮质骨螺钉与椎弓根螺钉行后路腰椎椎间融合术的研究。提取出各研究中的数据并整理为表格,并将该研究数据利用Rev Man 5.3软件进行Meta分析与综合。结果与结论:①共12篇文献、929例患者纳入Meta分析,其中有2篇文献为随机对照试验,10篇为队列研究,文献质量评估提示纳入文献质量较高;②Meta结果提示,与椎弓根螺钉组相比,皮质骨螺钉组在术中出血量(MD=-68.77,95%CI:-84.33至-53.21)、手术时间(MD=-28.96,95%CI:-53.11至-4.82)、住院时间(MD=-1.59,95%CI:-2.58至-0.59)、围术期并发症(OR=-1.95,95%CI:-4.11-0.20)上差异有显著性意义(P<0.05),而目测类比背痛、目测类比腿痛评分、术后Oswestry功能障碍指数问卷表评分、术后日本骨科协会评分评分、远期并发症、融合率方面无显著差异;③上述数据证实,应用皮质骨螺钉行后路腰椎椎间融合术较椎弓根螺钉可明显减少术中出血量、手术时间、住院时间和围术期并发症,但仍需要更多的前瞻性、大样本随机对照研究提供一级证据来验证。

BACKGROUND:Currently,pedicle screw fixation is widely used in posterior lumbar interbody fusion.However,due to its shortcomings such as the need of extensive muscle dissection,and invasion of adjacent joints,since 2009,cortical screws were introduced to administrate posterior lumbar interbody fusion in order to reduce intraoperative blood loss and related surgical complications.At present,there are some shortages in the meta-analyses comparing cortical screws with pedicle screws in the use of posterior lumbar interbody fusion,such as including studies with the inconsistent operative methods,or including studies with relatively short follow-up time,or analyses with a rather small sample sizes.OBJECTIVE:To compare the clinical efficacy of cortical bone trajectory screw and pedicle screw fixation in posterior lumbar interbody fusion.METHODS:The computer was used to search for studies of comparing clinical efficacy of cortical bone trajectory screw fixation and pedicle screw fixation in posterior lumbar interbody fusion in PubMed,Embase,Web of Science,China Biology Medicine disc,China National Knowledge Infrastructure and Wanfang database from January 2009 to January 1,2020.The data in each research were extracted and sorted into tables.The research data were meta-analyzed and synthesized by RevMan 5.3 software.RESULTS AND CONCLUSION:(1)A total of 12 articles that met the study criteria,including 2 randomized controlled trials and 10 cohort studies with 929 patients were included in the analysis database.Quality assessment indicated that the included studies had relatively high quality.(2)Meta-analysis results indicated that compared with pedicle screw group,intraoperative blood loss(MD=-68.77,95%CI:-84.33 to-53.21),operation time(MD=-28.96,95%CI:-53.11 to-4.82),hospitalization time(MD=-1.59,95%CI:-2.58 to-0.59)and perioperative complications(OR=-1.95,95%CI:-4.11-0.20)were statistically significant in the cortical bone trajectory screw group(P<0.05).Postoperative visual analogue scale back pain score,visual analogue scale leg pain score,Oswestry Dysfunction Index,Japanese orthopaedic association score,long-term complications and fusion rate were not statistically significant.(3)Above data verified that compared with pedicle screw,cortical bone trajectory screw in posterior lumbar interbody fusion can reduce intraoperative blood loss,shorten the operation time and hospitalization time and reduce perioperative complications.However,more prospective,large-scale randomized controlled trials are still needed to provide first-class evidence for verification.