方法:系统文献综述。
目的:分析使用脱矿质骨基质(DBM)的单节或双节段颈前路椎间盘切除术和融合术(ACDF)中可报告的并发症的证据,羟基磷灰石(HA),或β-磷酸三钙(β-TCP)。
方法:使用PubMed对文献进行系统回顾,EMBASE,科克伦图书馆,和ClinicalTrials.gov数据库于2020年8月进行,以确定使用DBM报告一级或二级ACDF手术并发症的研究,HA,或β-TCP。该研究是根据系统评价和荟萃分析(PRISMA)指南的首选报告项目进行报告的。
结果:共纳入1857例患者,981名男性和876名女性,共17篇文章;5篇前瞻性,12回顾我们注意到纳入的研究中涉及研究设计和其中使用的移植材料的组合的异质性。然而,我们注意到在使用DBM的融合构建体中,邻近节段疾病(17.7%)和假关节(9.3%)的发生率较高.使用β-TCP的研究报告假关节病(28.2%)和植入物失败(17.9%)的发生率更高。
结论:使用DBM进行一级或二级ACDF手术治疗退行性宫颈疾病,HA,或β-TCP伴或不伴宫颈板与并发症相关,如相邻节段疾病,吞咽困难,和假关节.然而,由于研究设计和研究的临床异质性,不可能将这些并发症与所使用的任何特定移植材料准确关联。需要进一步精心设计的前瞻性研究来正确了解用于在ACDF中实现融合的每个移植物的相关发病率。
METHODS: Systematic literature review.
OBJECTIVE: To analyze the evidence available reporting complications in single or two-level anterior cervical discectomy and fusion (ACDF) using a demineralized bone matrix (DBM), hydroxyapatite (HA), or beta-tricalcium phosphate (β-TCP).
METHODS: A systematic review of the literature using PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov databases was performed in August 2020 to identify studies reporting complications in one or two-level ACDF surgery using DBM, HA, or β-TCP. The study was reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.
RESULTS: A total of 1857 patients were included, 981 male and 876 female, across 17 articles; 5 prospective, and 12 retrospectives. We noted heterogeneity among the included studies concerning the study design and combination of graft materials utilized in them. However, we noted a higher incidence of adjacent segment disease (17.7%) and pseudoarthrosis (9.3%) in fusion constructs using DBM. Studies using β-TCP reported a higher incidence of pseudoarthrosis (28.2%) and implant failures (17.9%).
CONCLUSIONS: Degenerative cervical conditions treated with one or two-level ACDF surgery using DBM, HA, or β-TCP with or without cervical plating are associated with complications such as adjacent segment disease, dysphagia, and pseudarthrosis. However, consequent to the study designs and clinical heterogeneity of the studies, it is not possible to correlate these complications accurately with any specific graft material employed. Further well-designed prospective studies are needed to correctly know the related morbidity of each graft used for achieving fusion in ACDF.