■这项荟萃分析旨在通过系统地比较围手术期数据来完善对经椎间孔腰椎椎间融合术(TLIF)中不同笼子形状之间的最佳选择的理解,放射学结果,临床结果,以及与香蕉形和直弹笼相关的并发症。
■包含PubMed的细致文献检索,Embase,Scopus,WebofScience,中国知网,和万方数据截至2023年10月5日执行。纳入标准侧重于比较TLIF中香蕉形和直子弹笼的研究。使用适当的工具评估纳入研究的质量,例如用于非随机研究的纽卡斯尔-渥太华量表(NOS)。对放射学结果进行了严格的评估,包括圆盘高度,节段前凸,腰椎前凸,沉降,和融合率。使用视觉模拟量表(VAS)仔细评估临床结果,Oswestry残疾指数(ODI),和并发症。
■该分析纳入了七项研究,涉及573名患者(297名香蕉形笼,276带直笼子),所有NOS评分超过5星。手术时间差异无统计学意义,失血,或两种笼子形状之间的住院治疗。香蕉形笼表现出较大的椎间盘高度变化(P=0.001),节段前凸(P=0.02),腰椎前凸(P=0.01)。尽管直笼的ODI变化具有统计学意义(26.33;P<0.0001),实际值与香蕉形笼子相似(26.15)。两种笼型在VAS中表现出相似的功效,并发症发生率,沉降,和融合率。
■尽管香蕉形的笼子可以在恢复光盘高度方面表现出色,节段前凸,和腰椎前凸,直的子弹笼可以提供可比的功能改进,疼痛缓解,和并发症发生率。
OBJECTIVE: This meta-analysis aims to refine the understanding of the optimal choice between different cage shapes in transforaminal lumbar interbody fusion (TLIF) by systematically comparing perioperative data, radiological outcomes, clinical results, and complications associated with banana-shaped and straight bullet cages.
METHODS: A meticulous literature search encompassing PubMed, Embase, Scopus, Web of Science, China Knowledge Network, and Wanfang Data was executed up to October 5, 2023. Inclusion criteria focused on studies comparing banana-shaped and straight bullet cages in TLIF. The quality of included studies was assessed using appropriate tools such as the Newcastle-Ottawa Scale (NOS) for nonrandomized studies. Rigorous evaluations were performed for radiographic outcomes, including disc height (DH), segmental lordosis (SL), lumbar lordosis (LL), subsidence, and fusion rates. Clinical outcomes were meticulously evaluated using visual analogue scale (VAS), Oswestry Disability Index (ODI), and complications.
RESULTS: The analysis incorporated 7 studies, involving 573 patients (297 with banana-shaped cages, 276 with straight cages), all with NOS ratings exceeding 5 stars. No statistically significant differences were observed in operative time, blood loss, or hospitalization between the 2 cage shapes. Banana-shaped cages exhibited greater changes in DH (p = 0.001), SL (p = 0.02), and LL (p = 0.01). Despite statistically higher changes in ODI for straight cages (26.33, p < 0.0001), the actual value remained similar to banana-shaped cages (26.15). Both cage types demonstrated similar efficacy in VAS, complication rates, subsidence, and fusion rates.
CONCLUSIONS: Although banana-shaped cages can excel in restoring DH, SL, and LL, straight bullet cages can provide comparable functional improvements, pain relief, and complication rates.