目的:机器人引导(RG)和计算机辅助导航(CAN)已越来越多地用于颈椎手术中的颈椎后路螺钉置入,颈椎螺钉错位可能导致灾难性并发症。然而,与传统徒手(FH)技术相比,使用RG或CAN导航的优越性仍存在争议,并且没有进行比较两种方法在颈椎手术中的荟萃分析。
方法:PubMed,Embase,WebofScience,科克伦,中国国家知识基础设施,和万方数据库进行了符合条件的文献检索。包括报告使用RG或CAN与FH技术相比颈椎螺钉放置准确性的主要结果的研究。使用Cochrane偏倚风险标准和纽卡斯尔-渥太华量表评估偏倚。根据比值比或标准化平均差和相应的95%置信区间评估结果。
结果:本荟萃分析包括2012年至2023年间发表的一项随机对照试验和18项比较队列研究,包括946例患者和4163例颈椎螺钉。与FH技术相比,RG和CAN技术具有更高的最佳和临床可接受的颈椎螺钉准确性。此外,与FH组相比,导航组显示术后不良事件较少,减少失血,住院时间缩短,术后颈部残疾指数评分较低。然而,导航组和FH组在最后一次随访时具有相同的术中时间和术后视觉模拟量表以及日本骨科协会评分.
结论:在颈椎螺钉放置的准确性方面,RG和CAN均优于FH技术。导航技术,包括RG和CAN方法,是准确的,安全,在颈椎手术中是可行的。
OBJECTIVE: Robot guidance (RG) and computer-assisted navigation (CAN) have been increasingly utilized for posterior cervical screw placement in cervical spine surgery, and cervical screw malposition may contribute to catastrophic complications. However, the superiority of the navigation using RG or CAN compared with conventional freehand (FH) techniques remains controversial, and no meta-analysis comparing the two methods in cervical spine surgery has been performed.
METHODS: The PubMed, Embase, Web of Science, Cochrane, China National Knowledge Infrastructure, and Wanfang databases were searched for eligible literature. Studies reporting the primary outcomes of the accuracy of cervical screw placement using RG or CAN compared with FH techniques were included. Bias was evaluated using the Cochrane risk of bias criteria and the Newcastle-Ottawa Scale. The outcomes were evaluated in terms of odds ratio or standardized mean difference and corresponding 95% confidence interval.
RESULTS: One randomized controlled trial and 18 comparative cohort studies published between 2012 and 2023 consisting of 946 patients and 4163 cervical screws were included in this meta-analysis. The RG and CAN techniques were associated with a substantially higher rate of optimal and clinically acceptable cervical screw accuracy than FH techniques. Furthermore, compared with the FH group, the navigation group showed fewer postoperative adverse events, less blood loss, shorter hospital lengths of stay, and lower postoperative Neck Disability Index scores. However, the navigation and FH groups had equivalent intraoperative times and postoperative visual analog scale and Japanese Orthopaedic Association scores at the final follow-up.
CONCLUSIONS: Both RG and CAN are superior to FH techniques in terms of the accuracy of cervical screw placement. Navigation techniques, including RG and CAN methods, are accurate, safe, and feasible in cervical spine surgery.