皮质骨轨迹螺钉与传统椎弓根螺钉固定对短节段腰椎融合术患者临床疗效影响的Meta分析

A meta-analysis of the influences of cortical bone trajectory screw versus traditional pedicle screw fixations on the clinical outcomes in short-segment lumbar fusion

目的:通过Meta分析系统评价皮质骨轨迹(cortical bone trajectory,CBT)螺钉与传统椎弓根螺钉(pedicle screw,PS)固定对短节段腰椎融合术患者临床疗效的影响,为脊柱外科医生选择相应的内固定方式提供理论参考。方法:检索PubMed、Scopus、Web of Science、EI和知网数据库自建库至2022年7月1日发表的对比CBT螺钉(CBT组)和PS(PS组)固定对腰椎椎间融合术疗效影响的文献,提取椎间融合率、手术并发症发生率、术后邻近节段退变(adjacent segment degeneration,ASD)发生率、术中失血量、手术时间、平均住院时间、背部疼痛视觉模拟评分(visual analog scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)和日本骨科协会(Japanese Orthopaedic Association,JOA)评分等指标,采用RevMan 5.3进行Meta分析。随机对照试验采用Cochrane风险偏倚评估标准,队列分析采用Newcastle-Ottawa Scale(NOS)风险偏倚评估标准对纳入文献质量进行评估。结果:共纳入15篇文献,其中3篇为随机对照试验,12篇为队列研究,文献质量评估结果显示纳入文献质量较高。通过Meta分析得出,与PS固定相比,CBT组手术并发症发生率[RR=0.49,95%CI(0.34,0.70),P<0.05]、术后ASD发生率[RR=0.33,95%CI(0.16,0.65),P<0.05]更低;术中出血量[SMD=-0.81,95%CI(-0.98,-0.63),P<0.05]更少;手术时间[SMD=-0.49,95%CI(-0.67,-0.30),P<0.05]及平均住院时间[SMD=-0.60,95%CI(-0.81,-0.38),P<0.05]更短;JOA评分[SMD=0.23,95%CI(0.02,0.43),P<0.05]更高;而两者在椎间融合率、背部疼痛VAS评分和ODI方面无统计学差异。结论:与应用PS固定相比,在短节段腰椎固定融合术中应用CBT螺钉固定的手术并发症发生率、术后ASD发生率较低,手术时间、住院时间较短,术中出血量较少,JOA评分较高。

Objectives:To evaluate the influences on the clinical outcomes of cortical bone trajectory(CBT)screw and pedicle screw(PS)fixations in short-segment lumbar interbody fusion by meta-analysis systematically,so as to provide a theoretical reference for spinal surgeons in selection of appropriate internal fixation methods.Methods:PubMed,Scopus,Web of Science,EI,CNKI and other databases were searched for the relevant literature on the comparison between CBT and PS fixations in lumbar interbody fusion from the inception to July 1,2022.The intervertebral fusion rate,incidence of surgical complications,incidence of postoperative adjacent segment degeneration(ASD),intraoperative blood loss,operation time,average length of hospital stay,visual analog scale(VAS)of back pain,Oswestry disability index(ODI),and Japanese Orthopaedic Association(JOA)score were extracted,and RevMan 5.3 software was used to perform meta-analysis.The Cochrane risk bias assessment criteria and Newcastle-Ottawa Scale(NOS)risk bias assessment criteria were used to evaluate the quality of enrolled studies respectively for randomized controlled trials and cohort studies.Results:A total of 15 literature were selected,among which 3 were randomized controlled trials and 12 were cohort studies.The evaluation of literature quality suggested that the included literature were of high quality.Meta-analysis showed that CBT group had lower incidence of surgical complications[RR=0.49,95%CI(0.34,0.70),P<0.05]and postoperative ASD incidence[RR=0.33,95%CI(0.16,0.65),P<0.05];less intraoperative blood loss[SMD=-0.81,95%CI(-0.98,-0.63),P<0.05];shorter operative time[SMD=-0.49,95%CI(-0.67,-0.30),P<0.05]and average length of hospital stay[SMD=-0.60,95%CI(-0.81,-0.38),P<0.05];higher JOA score[SMD=0.23,95%CI(0.02,0.43),P<0.05].However,there was no significant difference in interbody fusion rate,back pain VAS score or ODI between the two groups.Conclusions:Comparing with PS fixation,CBT screw fixation was lower in the incidence of surgical complications and postoperative ASD,less in intraoperative blood loss,shorter in operative time and length of hospital stay,and higher in JOA score in short-segment lumbar interbody fusion.