导航模板辅助脊柱椎弓根内固定术与传统椎弓根内固定术手术效果比较的Meta分析

目的:系统评价快速成型导航模板辅助脊柱椎弓根内固定术与传统通过解剖标志定位的内固定术的优良率与疗效。方法:计算机检索2017年6月前PubMed、The Cochrane Library(2017年5期)、Clinical Trial、Google Scholar、Web of Science、中国知网(CNKI)、万方(Wanfang Data)和维普(VIP)等中英文数据库,查找有关于导航模板辅助脊柱椎弓根螺钉置入与传统置入术临床疗效对比的临床随机对照试验(RCT)和前瞻性病例对照研究或回顾性病例对照研究。由2位研究者分别根据纳入与排除标准进行文献筛选、数据提取,通过Cochrane Handbook对纳入的随机对照试验进行方法学质量评价,通过NOS量表对纳入的前瞻性病例对照研究和回顾性病例对照研究进行方法学质量评价,采用Cochrane协作网RevMan 5.3软件对两种椎弓根螺钉置入方式所得疗效指标进行Meta分析。结果:最终共纳入7篇文献,包括2篇RCT、1篇前瞻性病例对照研究和4篇回顾性病例对照研究,共计237例患者,置入椎弓根螺钉1 688枚,其中导航模板组898枚螺钉,传统手术组790枚螺钉。Meta分析结果显示:导航模板组与传统手术组在螺钉置入优良率的差异有统计学意义OR=5.05,95%CI(3.13,8.16),P0.000 01];两组胸腰段手术时间存在差异,且差异具有统计学意义WMD=-27.19,95%CI(-38.21,-16.17),P0.000 01];两组术中出血量存在差异,且差异有统计学差异WMD=-100.82,95%CI(-182.26,-19.37),P=0.02]。结论:导航模板脊柱椎弓根螺钉内固定术与传统椎弓根螺钉内固定术相比具有更好的临床疗效,可以提高螺钉置入的优良率,减少手术时间及术中出血量。

Comparison of the effect of navigation template assisted spinal pedicle fixation and traditional pedicle screw fixation:a Meta-analysis

Objective: To systematically evaluate the efficacy of rapid prototyping drill navigation template-assisted pedicle screw fixation and traditional anatomic landmark-based fixation in the treatment of spinal disease by accessing and searching some relevant literatures home and abroad.Methods: Randomized Controlled Trials (RCTs) and prospective case-control studies or retrospective case-control studies about rapid prototyping drill templates-assisted pedicle screw fixation and traditional anatomic landmark-based fixation for the treatment of spinal disease were searched electronically in PubMed, The Cochrane Library (Issue 5, 2017), Clinical Trial, Google Scholar, Web of Science, CNKI, Wanfang database and VIP database before June 2017. According to the inclusion and exclusion criteria, two researchers independently screened the literatures, and extracted the data. The methodological quality of randomized controlled trials were evaluated by the Cochrane Handbook, and prospective case-control studies and retrospective case-control studies were evaluated by the NOS scale. The outcomes were analyzed using RevMan 5.3 software provided by the Cochrane information management system.Results: A total of 7 articles were included, including 2 RCTs, 1 prospective case-control study and 4 retrospective case-control studies. A total of 237 patients were implanted with 1 688 pedicle screws, including 898 screws in the navigation template group, 790 screws in the conventional method group. Meta-analysis results showed that there was significant difference in the excellent rate of screw implantation between navigation template group and conventional method groupOR=5.05, 95% CI (3.13, 8.16), P<0.000 01], there was significant difference in operative time, intraoperative blood loss for thoracolumbar surgeryWMD=-27.19, 95% CI (-38.21, -16.17), P<0.000 01;WMD=-100.82, 95% CI (-182.26, -19.37), P=0.02].Conclusion: Compared with traditional pedicle screw fixation, navigation template spine pedicle screw fixation has better clinical effect, which can improve the excellent rate of screw placement, reduce the operation time and intraoperative bleeding.