腰椎椎体间融合术后cage后移危险因素的Meta分析

A meta-analysis of risk factors for cage retropulsion after lumbar interbody fusion

中文关键词:  腰椎椎间融合术  cage后移  危险因素  Meta分析

英文关键词:Lumbar fusion  Cage retropulsion(CR)  Risk factors  Meta-analysis

中文摘要:

  【摘要】 目的：通过系统评价的方法分析影响腰椎椎体间融合术后cage后移（cage retropulsion，CR）发生的危险因素。方法：检索PubMed、Embase、Cochrane Library、Web of Science、中国生物医学文献数据库（CBM）、中国知网（CNKI）、万方数据库和维普数据库，收集各数据库建库至2023年4月有关影响腰椎椎体间融合术后CR危险因素的文献，研究类型为队列研究及病例对照研究，采用纽卡斯尔-渥太华质量评估量表（Newcastle-Ottawa scale，NOS）对纳入研究进行质量评价，提取纳入研究的基本信息，包括年龄及性别等以及CR发生相关研究因素，如骨质疏松、终板损伤、螺钉松动、梨形椎间隙、cage形状、cage置入深度及手术时长、出血量等。评价纳入研究的偏倚风险后，使用Stata14.0软件进行Meta分析。结果：共纳入16篇相关文献，其中15篇文献为回顾性病例对照研究，1篇为前瞻性队列研究，均为中等及以上质量研究，NOS评分均≥7分。总样本量12667例，其中发生CR者（CR组）326例，未发生CR者（nCR组）12341例，CR发生率为2.83%。Meta分析结果显示：性别（男性）[比值比（odds ratio，OR）=1.264，95%置信区间（confidence interval，CI）（1.003～1.593），P=0.047]、年龄[效应量标准化平均差（standardized mean difference，SMD）=0.237，95%CI（0.054～0.419），P=0.011]、骨质疏松[OR=3.126，95%CI（1.040～9.401），P=0.042]、骨终板损伤[OR=8.161，95%CI（3.711～17.945），P=0.000]、螺钉松动[OR=7.978，95%CI（3.487～18.255），P=0.000]、梨形椎间隙[OR=6.037，95%CI（2.381～15.305），P=0.000]、cage置入深度不足[OR=5.157，95%CI（1.760～15.111），P=0.003]是腰椎椎体间融合术后发生CR的危险因素。结论：性别（男性）、高龄、骨质疏松、骨终板损伤、螺钉松动、梨形椎间隙、cage置入深度不足与腰椎椎体间融合术后发生CR密切相关，随访期间应对此类患者密切观察，预防发生严重cage移位的并发症。

英文摘要:

  【Abstract】 Objectives: To analyze the risk factors affecting the occurrence of cage retropulsion(CR) after lumbar interbody fusion surgery through systematic evaluation. Methods: By searching PubMed, Embase, Cochrane Library, Web of Science, CBM, CNKI, Wanfang and VIP databases, relevant literature related to the risk factors affecting CR after lumbar interbody fusion were collected from the inception of each database to April 2023. The study type was cohort study and case-control study, and the Newcastle-Ottawa scale(NOS) was used to evaluate the quality of the included studies. Basic information such as gender and age and CR related factors such as osteoporosis, endplate injury, pear-shaped disc, cage position, screw loosening, and so on were extracted. After assessing the risk of bias in the included studies, a meta-analysis was performed using Stata14.0 software. Results: A total of 16 relevant studies were included, among them, 15 articles were retrospective case-control studies and 1 article was a prospective cohort study, all of moderate or higher quality, with a quality score ≥7 points on average. The sample size was 12667 patients, and among which 326 cases developed CR(CR group) and 12341 cases didn′t developed CR(nCR group), with a CR incidence rate of 2.83%. The results of meta-analysis showed that gender(man)[odds ratio(OR)=1.264, 95% confidence interval(CI)(1.003-1.593), P=0.047], age[standardized mean difference(SMD)=0.237, 95%CI(0.054-0.419), P=0.011], osteoporosis[OR=3.126, 95%CI(1.040-9.401), P=0.042], endplate injury[OR=8.161, 95%CI(3.711-17.945), P=0.000], screw loosening[OR=7.978, 95%CI(3.487-18.255), P=0.000], pear-shaped disc[OR=6.037, 95%CI(2.381-15.305), P=0.000], and cage in poor position[OR=5.157, 95%CI(1.760-15.111), P=0.003] were the risk factors for CR after lumbar interbody fusion. Conclusions: Gender(man), age, osteoporosis, endplate injury, screw loosening, pear-shaped disc, and cage in poor position are closely related to CR after lumbar interbody fusion, and close attention needs to be paid to such patients to prevent complications of severe cage displacement during follow-up.