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

Cortical bone trajectory screws vs pedicle screws in posterior lumbar fusion: a Meta-analysis

中文关键词:  皮质骨通道  皮质骨螺钉  椎弓根螺钉  腰椎  Meta分析

英文关键词:Cortical bone trajectory  Cortical screw  Pedicle screw  Lumbar  Meta-analysis

中文摘要:

  【摘要】 目的：应用Meta分析评价腰椎后路融合术中皮质骨通道（CBT）螺钉固定与传统椎弓根螺钉（PS）固定的效果，为临床选择合适的固定方法提供依据。方法：计算机检索CNKI、CBM、PubMed、The Cochrane Library（2017年第6期）、ELSEVIER Science Direct（SDOS）数据库，检索时间均是从建库到2017年6月。搜集腰椎后路融合术中应用CBT螺钉固定与PS固定的随机对照研究（RCT）和队列研究，均经X线、CT及MRI 确定诊断患有某些腰椎疾病（包括腰椎椎间孔狭窄的椎管狭窄症和重度滑脱症）；年龄40~60岁。术后结局指标至少包括以下指标中的一项：Oswestry残障指数（Oswestry disability index，ODI）、日本骨科协会（Japanese Orthopaedic Association，JOA）评分、视觉模拟评分（visual analogue score，VAS）、术中出血量、手术时间、融合情况。参考Cochrane系统评价手册5.0.1和修改后的纽卡斯尔渥太华评分（针对RCT和队列研究的评价标准）对纳入文献质量进行评价，并采用Meta分析对相关结局指标进行分析。结果：共纳入1个RCT，6个队列研究，7篇均为英文文献。CBT组共计259例，PS组共计289例。Meta分析结果显示：CBT组和PS组术中出血量有统计学差异[MD=-88.83，95%CI（-122.79，-54.88），P＜0.01]，而ODI（P=0.20）、JOA评分（P=0.57）、VAS评分（术后1个月腰痛P=0.38，术后8个月腰痛P=0.89，术后8个月腿痛P=0.51)、手术时间（P=0.12）、融合（P=0.95）五个方面两组无统计学差异。结论：与PS固定技术相比，应用CBT螺钉固定技术行腰椎后路融合也可获得满意的临床疗效，而且能显著减少术中出血量。

英文摘要:

  【Abstract】 Objectives: To assess the efficacy of cortical bone trajectory(CBT) screw and pedicle screw(PS) technique in posterior lumbar fusion, and to provide evidence for clinical procedure. Methods: Databases including CNKI, CBM, PubMed, The Cochrane Library(Issue 6, 2017), ELSEVIER Science Direct(SDOS) were used to collect randomized controlled trials(RCTs) and cohort study which compared CBT screw fixation with PS fixation in posterior lumbar fusion from inception to June 2017. X-ray, CT and MRI confirmed the diagnosis(including lumbar intervertebral foramen stenosis in lumbar spinal stenosis and severe spondylolisthesis); the ages ranged from 40 to 60 years old. The outcome measures included at least one of the following indicators: the Oswestry disability index(ODI), the Japanese Orthopedic Association(JOA) scale, the visual analogue scale(VAS), the intraoperative blood loss, the operation time, and the fusion outcomes. The quality of the included literature was evaluated by using the Cochrane systematic review manual 5.0.1(an evaluation criteria for randomized controlled trials) and the revised Newcastle Ottawa score(an evaluation criteria for cohort studies), and the Meta-analysis method was used to analyze the related outcome indexes. Results: A total of 1 RCT and 6 cohort studies in English literature were included. 259 cases in group CBT and 289 cases in group PS. Meta-analysis showed that: the amount of bleeding was significantly different between the two groups[MD=-88.83,95%CI(-122.79, -54.88), P<0.01], while no significant differences were found in ODI and JOA scale, VAS, operation time, and fusion outcomes between the two groups(P>0.05). Conclusions: Compared with PS, CBT screw fixation in posterior lumbar fusion can reduce blood loss during operation.