皮质骨通道螺钉与椎弓根螺钉固定用于后路腰椎椎体间融合的Meta分析
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摘要
背景:传统椎弓根螺钉固定技术现广泛用于后路腰椎椎体间融合手术中,由于其广泛的软组织剥离及易侵犯椎间关节等较多并发症,2009年后逐渐将皮质骨通道螺钉固定技术应用于后路腰椎椎体间融合术中以减少并发症,目前尚未有单独的Meta分析对皮质骨通道螺钉固定技术与传统椎弓根螺钉固定技术在后路腰椎椎体间融合术后的临床疗效进行研究。目的:运用Meta分析法对椎弓根皮质骨通道螺钉固定与传统椎弓根螺钉固定在后路腰椎椎体间融合术后的临床疗效进行系统评价。方法:计算机检索PubMed、The Cochrane Library、Embase、Scopus、Web of Science、中国知网(CNKI)、中国生物医学系统(CBM)、万方等数据库中进行检索,以CBT、cortical bone trajectory、cortical screw、PS、Pedicle Screw、皮质骨通道螺钉、椎弓根螺钉等为关键词,检索时间从建库到2018年7月。由2名研究者独立对检索到的文献进行筛选并对纳入文献进行质量评价和数据提取,使用RevMan5.2软件进行Meta分析。结果与结论:(1)共纳入8篇文献,其中英文文献7篇,中文文献1篇;随机对照试验2篇,队列研究6篇;共纳入病例656例,其中皮质骨通道螺钉组319例,椎弓根螺钉组337例;(2)Meta分析结果显示,2组在手术时间、术中出血量、术后住院时间方面差异有显著性意义,皮质骨通道螺钉优于传统椎弓根螺钉组(P <0.05);(3)2组在围术期并发症、术后随访期间总并发症及二次手术率方面差异有显著性意义,皮质骨通道螺钉优于传统椎弓根螺钉组(P <0.05);(4)在远期并发症及椎间融合率方面2组差异无显著性意义(P> 0.05);(5)提示与传统椎弓根螺钉骨钉技术相比,在后路腰椎椎体间融合术中皮质骨通道螺钉在手术时间、术中出血量、术后住院时间、围术期并发症、总并发症及二次手术率等临床效果方面有明显优势,但在椎间融合率及远期并发症方面两者并无明显差异。
BACKGROUND: Traditional pedicle screw fixation technique has been widely used in posterior lumbar interbody fusion. Because of its complications such as extensive soft tissue dissection and invasion of intervertebral joints, since 2009, cortical bone trajectory screw fixation technique has been gradually used in posterior lumbar interbody fusion surgery in order to reduce these complications. There is a lack of meta-analysis exploring the clinical efficacy of cortical bone trajectory screw fixation versus traditional pedicle screw fixation after posterior lumbar interbody fusion.OBJECTIVE: To evaluate the clinical efficacy of cortical bone trajectory screw fixation versus traditional pedicle screw fixation after posterior lumbar interbody fusion by meta-analysis. METHODS: A computer-based search in databases of PubMed, The Cochrane Library, Embase, Scopus, Web of Science, CNKI, CBM, and WanFang was conducted for the articles published before July 2018. "CBT, cortical bone trajectory, cortical screw, PS, pedicle screw" were used as keywords in English and Chinese, respectively. Two researchers independently screened the retrieved literature, evaluated the quality of the included literature and extracted the data. Meta-analysis was performed using Rev Man 5.2 software. RESULTS AND CONCLUSION:(1) A total of eight literatures were included, including seven in English and one in Chinese, two randomized controlled trials, and six cohort studies. 656 cases were included, 319 in cortical trajectory screw group and 337 in pedicle screw group.(2) The results of meta-analysis showed that there were significant differences in operation time, intraoperative blood loss and postoperative hospitalization time between two groups, and the cortical trajectory screw group was superior to the pedicle screw group(P < 0.05).(3) There were significant differences in the perioperative complications, total complications during follow-up and secondary operation rate between two groups, and the cortical trajectory screw group was superior to the pedicle screw group(P < 0.05).(4) The long-term complications and intervertebral fusion rate did not differ significantly between two groups(P > 0.05).(5) These results indicate that the cortical bone trajectory screws are better than the traditional pedicle screws in the operation time, intraoperative blood loss, postoperative hospitalization time, perioperative complications, total complications and secondary operation rate. But there is no significant difference in the intervertebral fusion rate and long-term complications between two methods.
BACKGROUND: Traditional pedicle screw fixation technique has been widely used in posterior lumbar interbody fusion. Because of its complications such as extensive soft tissue dissection and invasion of intervertebral joints, since 2009, cortical bone trajectory screw fixation technique has been gradually used in posterior lumbar interbody fusion surgery in order to reduce these complications. There is a lack of meta-analysis exploring the clinical efficacy of cortical bone trajectory screw fixation versus traditional pedicle screw fixation after posterior lumbar interbody fusion.OBJECTIVE: To evaluate the clinical efficacy of cortical bone trajectory screw fixation versus traditional pedicle screw fixation after posterior lumbar interbody fusion by meta-analysis. METHODS: A computer-based search in databases of PubMed, The Cochrane Library, Embase, Scopus, Web of Science, CNKI, CBM, and WanFang was conducted for the articles published before July 2018. "CBT, cortical bone trajectory, cortical screw, PS, pedicle screw" were used as keywords in English and Chinese, respectively. Two researchers independently screened the retrieved literature, evaluated the quality of the included literature and extracted the data. Meta-analysis was performed using Rev Man 5.2 software. RESULTS AND CONCLUSION:(1) A total of eight literatures were included, including seven in English and one in Chinese, two randomized controlled trials, and six cohort studies. 656 cases were included, 319 in cortical trajectory screw group and 337 in pedicle screw group.(2) The results of meta-analysis showed that there were significant differences in operation time, intraoperative blood loss and postoperative hospitalization time between two groups, and the cortical trajectory screw group was superior to the pedicle screw group(P < 0.05).(3) There were significant differences in the perioperative complications, total complications during follow-up and secondary operation rate between two groups, and the cortical trajectory screw group was superior to the pedicle screw group(P < 0.05).(4) The long-term complications and intervertebral fusion rate did not differ significantly between two groups(P > 0.05).(5) These results indicate that the cortical bone trajectory screws are better than the traditional pedicle screws in the operation time, intraoperative blood loss, postoperative hospitalization time, perioperative complications, total complications and secondary operation rate. But there is no significant difference in the intervertebral fusion rate and long-term complications between two methods.
引文
[1]Cloward RB. The treatment of ruptured lumbar intervertebral discs by vertebral body fusion. I. Indications, operative technique, after care. J Neurosurg. 1953;10(2):154-168.
[2]Santoni BG, Hynes RA, McGilvray KC, et al. Cortical bone trajectory for lumbar pedicle screws. Spine J. 2009;9(5):366-373.
[3]高海,李惠民,陈银河,等.皮质骨螺钉固定与椎弓根螺钉固定在腰椎后路融合术中应用效果比较的Meta分析[J].中国脊柱脊髓杂志,2017,27(11):977-984.
[4]Keorochana G, Pairuchvej S, Trathitephun W, et al.Comparative Outcomes of Cortical Screw Trajectory Fixation and Pedicle Screw Fixation in Lumbar Spinal Fusion:Systematic Review and Meta-analysis. World Neurosurg.2017;102:340-349.
[5]Alderson P, Green S, Higgins JP, eds. Cochrane Reviewers'Handbook 4.2.1[updated December 2003]. Section 6. In:The Cochrane Library. The Cochrane Collaboration. Oxford, 2004.Issue 1.
[6]Sakaura H, Miwa T, Yamashita T, et al. Posterior lumbar interbody fusion with cortical bone trajectory screw fixation versus posterior lumbar interbody fusion using traditional pedicle screw fixation for degenerative lumbar spondylolisthesis:a comparative study. J Neurosurg Spine.2016; 25(5):591-595.
[7]Takenaka S, Mukai Y, Tateishi K, et al. Clinical Outcomes After Posterior Lumbar Interbody Fusion:Comparison of Cortical Bone Trajectory and Conventional Pedicle Screw Insertion. Clin Spine Surg. 2017;30(10):E1411-E1418.
[8]Lee GW, Son JH, Ahn MW, et al. The comparison of pedicle screw and cortical screw in posterior lumbar interbody fusion:a prospective randomized noninferiority trial. Spine J. 2015;15(7):1519-1526.
[9]彭俊,詹玉林,刘英杰,等.皮质骨通道螺钉与椎弓根螺钉行腰椎后路椎间融合的疗效比较[J].中国修复重建外科杂志, 2017,31(11):1341-1345.
[10]Marengo N, Ajello M, Pecoraro MF, et al. Cortical Bone Trajectory Screws in Posterior Lumbar Interbody Fusion:Minimally Invasive Surgery for Maximal Muscle Sparing-A Prospective Comparative Study with the Traditional Open Technique. Biomed Res Int. 2018;2018:7424568.
[11]Sakaura H, Miwa T, Yamashita T, et al. Cortical bone trajectory screw fixation versus traditional pedicle screw fixation for 2-level posterior lumbar interbody fusion:comparison of surgical outcomes for 2-level degenerative lumbar spondylolisthesis. J Neurosurg Spine. 2018;28(1):57-62.
[12]Hung CW, Wu MF, Hong RT, et al. Comparison of multifidus muscle atrophy after posterior lumbar interbody fusion with conventional and cortical bone trajectory. Clin Neurol Neurosurg. 2016;145:41-45.
[13]Lee GW, Ahn MW. Comparative Study of Cortical Bone Trajectory-Pedicle Screw(Cortical Screw)Versus Conventional Pedicle Screw in Single-Level Posterior Lumbar Interbody Fusion:A 2-Year Post Hoc Analysis from Prospectively Randomized Data. World Neurosurg. 2018;109:e194-e202.
[14]Stevens CD, Dubois RW, Larequi-Lauber T, et al. Efficacy of lumbar discectomy and percutaneous treatments for lumbar disc herniation. Soz Praventivmed. 1997;42(6):367-379.
[15]Rasouli MR, Rahimi-Movaghar V, Shokraneh F, et al.Minimally invasive discectomy versus microdiscectomy/open discectomy for symptomatic lumbar disc herniation. Cochrane Database Syst Rev. 2014;(9):CD010328.
[16]Matsukawa K, Yato Y, Kato T, et al. In vivo analysis of insertional torque during pedicle screwing using cortical bone trajectory technique. Spine(Phila Pa 1976). 2014;39(4):E240-245.
[17]Kaye ID, Prasad SK, Vaccaro AR, et al. The Cortical Bone Trajectory for Pedicle Screw Insertion. JBJS Rev. 2017;5(8):e13.
[18]Rodriguez A, Neal MT, Liu A, et al. Novel placement of cortical bone trajectory screws in previously instrumented pedicles for adjacent-segment lumbar disease using CT image-guided navigation. Neurosurg Focus. 2014;36(3):E9.
[2]Santoni BG, Hynes RA, McGilvray KC, et al. Cortical bone trajectory for lumbar pedicle screws. Spine J. 2009;9(5):366-373.
[3]高海,李惠民,陈银河,等.皮质骨螺钉固定与椎弓根螺钉固定在腰椎后路融合术中应用效果比较的Meta分析[J].中国脊柱脊髓杂志,2017,27(11):977-984.
[4]Keorochana G, Pairuchvej S, Trathitephun W, et al.Comparative Outcomes of Cortical Screw Trajectory Fixation and Pedicle Screw Fixation in Lumbar Spinal Fusion:Systematic Review and Meta-analysis. World Neurosurg.2017;102:340-349.
[5]Alderson P, Green S, Higgins JP, eds. Cochrane Reviewers'Handbook 4.2.1[updated December 2003]. Section 6. In:The Cochrane Library. The Cochrane Collaboration. Oxford, 2004.Issue 1.
[6]Sakaura H, Miwa T, Yamashita T, et al. Posterior lumbar interbody fusion with cortical bone trajectory screw fixation versus posterior lumbar interbody fusion using traditional pedicle screw fixation for degenerative lumbar spondylolisthesis:a comparative study. J Neurosurg Spine.2016; 25(5):591-595.
[7]Takenaka S, Mukai Y, Tateishi K, et al. Clinical Outcomes After Posterior Lumbar Interbody Fusion:Comparison of Cortical Bone Trajectory and Conventional Pedicle Screw Insertion. Clin Spine Surg. 2017;30(10):E1411-E1418.
[8]Lee GW, Son JH, Ahn MW, et al. The comparison of pedicle screw and cortical screw in posterior lumbar interbody fusion:a prospective randomized noninferiority trial. Spine J. 2015;15(7):1519-1526.
[9]彭俊,詹玉林,刘英杰,等.皮质骨通道螺钉与椎弓根螺钉行腰椎后路椎间融合的疗效比较[J].中国修复重建外科杂志, 2017,31(11):1341-1345.
[10]Marengo N, Ajello M, Pecoraro MF, et al. Cortical Bone Trajectory Screws in Posterior Lumbar Interbody Fusion:Minimally Invasive Surgery for Maximal Muscle Sparing-A Prospective Comparative Study with the Traditional Open Technique. Biomed Res Int. 2018;2018:7424568.
[11]Sakaura H, Miwa T, Yamashita T, et al. Cortical bone trajectory screw fixation versus traditional pedicle screw fixation for 2-level posterior lumbar interbody fusion:comparison of surgical outcomes for 2-level degenerative lumbar spondylolisthesis. J Neurosurg Spine. 2018;28(1):57-62.
[12]Hung CW, Wu MF, Hong RT, et al. Comparison of multifidus muscle atrophy after posterior lumbar interbody fusion with conventional and cortical bone trajectory. Clin Neurol Neurosurg. 2016;145:41-45.
[13]Lee GW, Ahn MW. Comparative Study of Cortical Bone Trajectory-Pedicle Screw(Cortical Screw)Versus Conventional Pedicle Screw in Single-Level Posterior Lumbar Interbody Fusion:A 2-Year Post Hoc Analysis from Prospectively Randomized Data. World Neurosurg. 2018;109:e194-e202.
[14]Stevens CD, Dubois RW, Larequi-Lauber T, et al. Efficacy of lumbar discectomy and percutaneous treatments for lumbar disc herniation. Soz Praventivmed. 1997;42(6):367-379.
[15]Rasouli MR, Rahimi-Movaghar V, Shokraneh F, et al.Minimally invasive discectomy versus microdiscectomy/open discectomy for symptomatic lumbar disc herniation. Cochrane Database Syst Rev. 2014;(9):CD010328.
[16]Matsukawa K, Yato Y, Kato T, et al. In vivo analysis of insertional torque during pedicle screwing using cortical bone trajectory technique. Spine(Phila Pa 1976). 2014;39(4):E240-245.
[17]Kaye ID, Prasad SK, Vaccaro AR, et al. The Cortical Bone Trajectory for Pedicle Screw Insertion. JBJS Rev. 2017;5(8):e13.
[18]Rodriguez A, Neal MT, Liu A, et al. Novel placement of cortical bone trajectory screws in previously instrumented pedicles for adjacent-segment lumbar disease using CT image-guided navigation. Neurosurg Focus. 2014;36(3):E9.