腰椎椎弓根螺钉内固定中计算机辅助导航应用的Meta分析

摘要

BACKGROUND:Computer-assisted navigation technique has been widely applied in spinal surgery, but there is stil lack of systematic reviews on this technique in lumbar pedicle screw fixation. OBJECTIVE:To evaluate the application of computer-assisted navigation technique in lumbar pedicle screw fixation. METHODS:Databases such as PubMed, Embase and China journal ful-text database CNKI were searched for articles about computer-assisted navigation in lumbar pedicle screw fixation, and related studies and literatures were hand-searched as wel , and then insertion accuracy, intraoperative blood loss, operative time consumption and rate of insertion-related complications between computer-assisted navigation technique group and conservative technique group were compared. RESULTS AND CONCLUSION:Final y 7 studies which met the inclusion criteria were included with 784 patients and 4 101 lumbar pedicle screws in total. Meta-analysis indicated that malposition rate [relative risk (RR)=0.44, 95%confidence interval (CI):(0.27, 0.69), P=0.000 4] and intraoperative blood loss [weighted mean difference (WMD)=-172.40, 95%CI:(-246.26,-98.53), P<0.000 01] had statistical y significant differences between computer-assisted navigation technique group and conservative insertion group. However, operative time consumption [WMD=-31.45, 95%CI:(-85.56, 22.66), P=0.25] and incidence of complications [RR=0.41, 95%CI:(0.12, 1.41), P=0.16] did not show significant differences between groups. Application of computer-assisted navigation technique in lumbar pedicle screw fixation would improve insertion accuracy. However, further study is stil needed to make clear whether this technique can improve final outcome in post-operative patients.%背景：计算机辅助导航技术在脊柱外科领域已得到广泛应用，但目前仍缺乏在腰椎椎弓根螺钉内固定术中应用该技术的系统评价。　　目的：评价计算机辅助导航技术在腰椎椎弓根螺钉固定过程中的价值。　　方法：通过计算机检索PubMed、Embase和中国期刊全文数据库CNKI等中英文数据库以及手工检索有关计算机辅助导航下腰椎椎弓根螺钉置入中的相关研究和文献，将计算机辅助导航置钉与传统置钉的置钉精度、术中出血量、手术用时、置钉相关并发症发生率等进行比较。　　结果与结论：共纳入7篇符合纳入标准的近期文献，累计病例784例，置入腰椎椎弓根螺钉4101枚。Meta分析表明，计算机辅助导航下置入腰椎椎弓根螺钉的置钉失误率[RR=0.44，95%CI：(0.27，0.69)，P=0.0004]与内固定中出血量[WMD=-172.40，95%CI：(-246.26，-98.53)，P<0.00001]与传统置钉方式相比差异有显著性意义，而手术用时[WMD=-31.45，95%CI：(-85.56，22.66)，P=0.25]与并发症发生率[RR=0.41，95%CI：(0.12，1.41)，P=0.16]则差异无显著性意义。计算机辅助导航技术在腰椎椎弓根螺钉固定术中的应用，可以提高置钉精度，但是否能改善患者内固定后的远期预后，目前仍需进一步研究。