目的:比较皮质骨轨迹(CBT)螺钉与椎弓根螺钉(PS)内固定治疗腰椎融合术后邻近节段退变(ASD)的疗效和安全性。
方法:本研究在国际前瞻性系统评价注册中心(PROSPERO)(ID:CRD42023484937)注册。我们搜索了PubMed,Embase,WebofScience,科克伦图书馆,中国国家知识基础设施(CNKI),万方数据库,通过计算机和韦普数据库收集从数据库建立到2023年11月对皮质骨轨迹(CBT)螺钉和椎弓根螺钉(PS)内固定治疗腰椎融合术后相邻节段退变(ASD)疗效和安全性的对照临床研究。两名研究人员筛选了文献,提取数据并评估纳入研究的偏倚风险,记录作者,和样本量,提取术中失血量,操作时间,Oswestry残疾指数(ODI),视觉模拟量表(VAS)圆盘高度(DH),每个研究的住院时间和并发症。采用CochraneLibrary提供的Revman5.4软件进行Meta分析。
结果:本研究共纳入6项队列研究(CS)和1项随机对照研究,共420名患者,其中CBT组188例,PS组232例。CBT组的术中出血量低于PS组[平均差异(MD)=-129.38,95%CI(-177.22,-81.55),P<0.00001],手术时间短于PS组[MD=-1.42,95%CI(-2.63,-0.20),P=0.02]。CBT组术后早期腰腿痛改善更显著[MD=-0.77,95%CI(-1.35,-0.19),P=0.01;MD=-0.24,95%CI(-0.37,-0.10),P=0.0005]。
结论:与PS相比,CBT治疗腰椎融合术后邻近节段退变具有术中出血量少,更短的操作时间,术后早期背部和腿部疼痛较少。
OBJECTIVE: To compare the efficacy and safety of cortical bone trajectory (CBT) screw and pedicle screw (PS) internal fixation in the treatment of adjacent segment degeneration (ASD) after lumbar fusion.
METHODS: This study was registered on International Prospective Register of Systematic Reviews (PROSPERO) (ID: CRD42023484937). We searched PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wan Fang Database, and Wei Pu Database by computer to collect controlled clinical studies on the efficacy and safety of cortical bone trajectory (CBT) screw and pedicle screw (PS) internal fixation in the treatment of adjacent segment degeneration (ASD) after lumbar fusion from database establishment to November 2023. Two researchers screened the literature, extracted data and evaluated the risk of bias of the included studies, recorded the authors, and sample size, and extracted the intraoperative blood loss, operation time, Oswestry disability index (ODI), Visual analogue scale (VAS), disc height (DH), hospital length stay and complications in each study. Meta-analysis was performed using Revman 5.4 software provided by Cochrane Library.
RESULTS: A total of 6 cohort studies (CS) and 1 randomized controlled study with a total of 420 patients were included in this study, including 188 patients in the CBT group and 232 patients in the PS group. The CBT group had lower intraoperative blood loss than the PS group [mean difference (MD) = -129.38, 95% CI (-177.22, -81.55), P < 0.00001] and operation time was shorter than that of the PS group [MD = -1.42, 95% CI (-2.63, -0.20), P = 0.02]. Early postoperative back and leg pain improved more significantly in the CBT group [MD = -0.77, 95% CI (-1.35, -0.19), P = 0.01; MD = -0.24, 95% CI (-0.37, -0.10), P = 0.0005].
CONCLUSIONS: Compared with PS, CBT for adjacent segment degeneration after lumbar fusion has the advantages of less intraoperative blood loss, shorter operation time, and less back and leg pain in the early postoperative period.