系统评价超声骨刀在脊柱手术中应用的有效性与安全性

A systematic literature review of ultrasonic bone curette application in spinal surgery

中文关键词:  超声骨刀  脊柱手术  有效性  安全性  系统评价

英文关键词:Ultrasonic bone curette  Spinal surgery  Effectiveness  Safety  Systematic review

中文摘要:

  【摘要】 目的：对脊柱手术中应用超声骨刀（ultrasonic bone curette，UBC）的有效性与安全性临床证据进行评估，提供循证医学证据。方法：计算机检索PubMed、Embase、中国知网、万方和维普数据库中2016年8月1日以前的文献，搜集关于脊柱手术中应用UBC的临床研究。两位研究者独立按纳入与排除标准筛选文献，提取数据，按The Journal of Bone & Joint Surgery（JBJS）的标准将研究的证据按方法学分为Ⅰ~Ⅴ级，并对有效性和安全性指标进行分析。结果：最终纳入26篇文献共1683个病例，包括2项随机对照研究（Ⅱ级证据），6项回顾性队列研究（Ⅲ级证据）和18项病例系列研究（Ⅳ级证据）。与传统工具相比，2项Ⅱ级和2项Ⅲ级研究支持UBC有更短的手术时间，2项Ⅱ级和3项Ⅲ级研究支持UBC有更少的出血量，2项Ⅲ级研究支持UBC有更短的平均住院日，2项Ⅲ级和2项Ⅳ级研究支持UBC有更低的器械相关并发症发生率，1项Ⅱ级研究支持UBC有更好的术后神经功能改善。大多数研究支持UBC在有效性和安全性指标方面优于或近似于传统工具，仅1项Ⅲ级研究在平均住院日方面有不同结论，但原作者认为结论有误。结论：在脊柱减压和截骨手术中应用UBC安全、有效，可以减少术中出血量、节省手术时间、缩短住院日及降低器械相关并发症。

英文摘要:

  【Abstract】 Objectives: To estimate evidence for the effectiveness and safety of ultrasonic bone curette(UBC) application in spinal surgery. Methods: A computer-based online search of Pubmed, Embase, CNKI, Wanfang and Weipu for articles published before August 1st, 2016 was performed to collect clinical articles about UBC application in spinal surgery. Two reviewers independently screened eligible articles basing on inclusion and exclusion criteria, extracted data, assessed level of evidence and recommendation grades. Results: 26 articles which encompassed 1,683 cases were finally identified for systematic review, including 2 randomized controlled trials(level Ⅱ), 6 retrospective cohort studies(level Ⅲ) and 18 case series(level　Ⅳ). Compared with traditional tools, 2 level Ⅱ and 2 level Ⅲ studies showed that UBC provided a shorter operation time, 2 level Ⅱ and 3 level Ⅲ studies showed that UBC provided a less estimated blood loss, 2 level Ⅲ studies showed that UBC provided a shorter length of hospital stay, 2 level Ⅲ and 2 level Ⅳ studies showed that UBC had a lower instrument-related complication rate, one level Ⅱ study showed that UBC had a better postoperative neurological improvement. Most studies showed that UBC provided better or similar effectiveness and safety than traditional tools, only one level Ⅲ study demonstrated an opposite result in length of hospital stay and the author interpreted it as an error. Conclusions: UBC is strongly recommended in various decompression and osteotomy procedures of spine surgery.