颈椎前路椎体次全切除融合术后钛网沉降发生率及危险因素的Meta分析

Meta-analysis of the incidence and risk factors for titanium mesh subsidence after anterior cervical corpectomy and fusion

中文关键词:  颈椎前路椎体次全切术  钛网沉降  发生率  危险因素

英文关键词:Anterior cervical corpectomy and fusion  Titanium mesh subsidence  Incidence rate  Risk factors

中文摘要:

  【摘要】 目的：系统评价颈椎前路椎体次全切除融合（anterior cervical corpectomy and fusion，ACCF）术后钛网沉降的发生率及危险因素，并探讨钛网沉降对临床疗效的影响。方法：检索中国知网（CNKI）、万方（WangFang）、维普（VIP）、中国生物医学文献数据库（CBM）、PubMed、Embase、Cochrane Library、Web of Science，收集各数据库建库至2024年6月有关ACCF术后钛网沉降危险因素的病例对照研究和队列研究，采用纽卡斯尔-渥太华质量评定量表（Newcastle-Ottawa Scale，NOS）对纳入文献进行质量评价，提取基本信息（第一作者、发表年份、研究类型、沉降定义、评估时间、样本量、沉降例数、沉降发生率）、报道的危险因素（年龄、性别、体重指数、手术节段、手术节段数、吸烟、高血压、糖尿病、融合节段高度、C2-7 Cobb角、节段角、椎体骨质量、钛网倾斜角、钛板种类、钉板角度、钛网放置位置等）、JOA评分及其改善率、椎间融合率。通过Stata 18.0软件进行Meta分析。结果：共纳入16项研究，均为病例对照研究，NOS评分均≥7分，共计1562例患者，其中钛网沉降患者555例。Meta分析结果显示：ACCF术后钛网沉降的发生率为37%；高龄[MD=2.680，95%CI（1.228，4.132），P=0.000]、女性[OR=0.71，95%CI（0.56，0.90），P=0.004]、吸烟[OR=1.924，95%CI（1.108，3.342），P=0.020]、骨质疏松[MD= -62.997，95%CI（-86.670，-39.323），P=0.000]、手术节段数过多[OR=0.096，95%CI（0.054，0.172），P=0.000]、钛网放置位置靠后[MD=0.743，95%CI（0.605，0.968），P=0.026]、椎间过度撑开[MD=1.317，95%CI（0.752，1.881），P=0.000]、节段角（钛网撑开角）[MD=0.887，95%CI（0.117，1.657），P=0.024]及钛网倾斜角过大[MD=4.475，95%CI（1.725，7.225）P=0.001]是ACCF术后钛网沉降的危险因素；钛网沉降的发生会导致患者颈椎JOA评分[MD= -0.542，95%CI（-0.947，-0.137），P=0.009]、JOA评分改善率[MD=-11.003，95%CI（-15.315，-6.691），P=0.000]以及椎间融合率[OR=3.003，95%CI（1.019，8.854），P=0.046]下降。结论：高龄、女性、吸烟、骨质疏松、手术节段数过多、钛网放置位置靠后、椎间过度撑开、钛网撑开角（节段角）及钛网倾斜角过大是ACCF术后发生钛网沉降的危险因素；ACCF术后钛网沉降会影响椎间融合，降低手术疗效，临床应给予重视。

英文摘要:

  【Abstract】 Objectives: To systematically evaluate the incidence and risk factors of titanium mesh subsidence following anterior cervical corpectomy and fusion(ACCF), and to explore the clinical impact of titanium mesh subsidence. Methods: Databases including CNKI, WangFang, VIP, China Biology Medicine disc(CBM), PubMed, Embase, Cochrane Library, and Web of Science were searched for case-control and cohort studies published from the inception of each database to June 2024 about the risk factors of titanium mesh subsidence following ACCF. The Newcastle-Ottawa scale(NOS) was used to assess the quality of the included studies. Basic information(first author, publication year, study type, definition of subsidence, assessment time, sample size, number of subsidence cases, and subsidence incidence), reported risk factors(age, sex, BMI, surgical segment, number of surgical segments, smoking, hypertension, diabetes, fusion segment height, C2-7 Cobb angle, segment angle, vertebral body quality, titanium mesh tilt angle, titanium plate type, screw-plate angle, and titanium mesh placement), cervical JOA score, JOA score improvement rate, and fusion rate were extracted and analyzed using Stata 18.0 software for meta-analysis. Results: A total of 16 studies were included, and all were case-control studies with NOS scores≥7. A total of 1562 patients were included, with 555 cases of titanium mesh subsidence. The meta-analysis showed that the incidence of titanium mesh subsidence after ACCF was 37%. Risk factors for titanium mesh subsidence included older age[MD=2.680, 95%CI(1.228, 4.132), P=0.000], female[OR=0.71, 95%CI(0.56, 0.90), P=0.004], smoking[OR=1.924, 95%CI(1.108, 3.342), P=0.020], osteoporosis[MD=-62.997, 95%CI(-86.670, -39.323), P=0.000], a big number of surgical segments[OR=0.096, 95%CI(0.054, 0.172), P=0.000], posterior placement of titanium mesh[MD=0.743, 95%CI(0.605, 0.968), P=0.026], excessive intervertebral distraction[MD=1.317, 95%CI(0.752, 1.881), P=0.000], segment angle(titanium mesh expansion angle)[MD=0.887, 95%CI(0.117, 1.657), P=0.024], and a big titanium mesh tilt angle[MD=4.475, 95%CI(1.725, 7.225), P=0.001]. Titanium mesh subsidence was associated with a decrease in cervical JOA score[MD=-0.542, 95%CI(-0.947, -0.137), P=0.009], JOA score improvement rate[MD=-11.003, 95%CI(-15.315, -6.691), P=0.000], and cervical fusion rate[OR=3.003, 95%CI(1.019, 8.854), P=0.046]. Conclusions: The current evidence indicates that older age, female, smoking, osteoporosis, a big number of surgical segments, posterior placement of titanium mesh, excessive intervertebral distraction, and big titanium mesh expansion angle(segment angle) and titanium mesh tilt angle are the risk factors for titanium mesh subsidence after ACCF. Cage subsidence after ACCF can impair intervertebral fusion and reduce the overall effectiveness of the surgery, and therefore warrants careful clinical attention.