导航下脊柱椎弓根钉置入与传统置入术临床疗效的Meta分析

目的:通过检索和分析国内外相关文献,评价导航辅助下椎弓根钉内固定术与传统通过解剖标志定位的内固定术的置钉位置优良率和临床疗效。方法:计算机检索1990年1月至2012年2月,Pubmed、Medline、OVID和万方医学网等中英文数据库并结合手工检索,按照既定的纳入和排除标准查找有关导航下脊柱椎弓根钉置入术与传统手术置钉术比较的临床随机对照试验(RCT)和前瞻性病例对照试验,对纳入的研究进行质量评价,使用RevMan5.1软件对数据进行Meta分析。结果:共纳入10篇文献,置入2813枚椎弓根钉,其中1561枚在导航辅助下置入,1252枚通过传统方式置入。研究结果提示导航辅助下置入椎弓根钉的优良率OR=2.58,95%CI(1.18,5.63)]、平均置入时间WMD=-2.15,95%CI(-2.36,-1.94)]与传统置入方式相比差异有统计学意义,且纳入研究未报道导航下置钉神经损伤相关并发症发生,仅一项研究报道导航辅助下钉道准备时间长于传统手术。结论:导航作为脊柱外科手术的一种辅助手段,可以提高置钉的优良率,加快置入的速度,减少置钉相关并发症,但由于该系统的复杂性可能导致钉道准备时间延长,尚需开展进一步的RCT研究加以验证。

Clinical efficiency of computer-assisted pedicle screw placement versus conventional method:a meta-analysis

Objective:To compare the clinical efficacy of computer-assisted pedicle screw placement and conventional placement in the treatment of spinal disease. Methods:A systematic search of studies published between Jan. 1990 and Feb. 2012 was conducted using Medline,Embase,OVID,ScienceDirect and Cochrane Review databases. Randomized controlled trials(RCTs) and prospective controlled trials of comparing computer-assisted pedicle screw placement to conventional method performed at one center or multi-centers providing data on accuracy of placement and clinical effects were identified. Two study authors independently reviewed the 93 articles originally identified and selected 10 for analysis. Study title,demographic characteristics,number of pedicle screw,anatomical area and outcomes were extracted manually from all selected studies. RevMan 5.1 software was used for meta-analysis. Results:Ten studies encompassing 2813 pedicle screws met the inclusion criteria. Overall,the result of meta-analysis indicated that there were significant differences between two groups in accuracy in placement of pedicle screw OR=2.58,95%CI(1.18,5.63)],insertion timeWMD=-2.15,95%CI(-2.36,-1.94)]. However,there was only one study reported preparation time of pedicle screw of navigation group was longer than conventional group. No neurological complication in navigation group was reported. Conclusion:As a safety supplementary measure,computer navigation provide better accuracy in placement of pedicle screw and insertion time. The preparation time of pedicle screw may prolong due to the complexity of navigation system. Further reseach should include randomized controlled trials with well-planned methodology to limit bias.