Wang Liang, Wang Yipeng, Yu Bin, Li Zhengyao, Li Ye
From the Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Medicine (Baltimore). 2015 Feb;94(5):e504. doi: 10.1097/MD.0000000000000504.
Percutaneous and open pedicle screw placements have been widely used in lumbar fusion surgery. However, there are conflicting reports of cranial facet joint violation rate for the 2 techniques. To better determine the rate of cranial facet joint violation, a systematic review and meta-analysis was performed in the present study. We searched the established electronic literature databases including MEDLINE, EMBASE, World of Science, and the Cochrane Central Register of Controlled Trials databases for trials involving the 2 pedicle screw placement techniques. Odds ratio (OR) and 95% confidence interval (CI) were calculated. Four comparative trials with a cumulative sample size of 881 patients and 1755 cranial pedicle screws were identified and analyzed. The results showed that cranial facet joint violation rate was 18.18% (154/847) in percutaneous group and 18.72% (170/908) in open group. The pooled data revealed that there was no significant difference in the violation rate (OR 0.75, 95% CI 0.24-2.30, P = 0.62). In addition, there was also no significant difference for the rate of severe violation between the 2 techniques (OR 1.20, 95% CI 0.55-2.62, P = 0.64, random effect model). Based on the current data, the meta-analysis shows that similar cranial facet joint violation rate occurs during the percutaneous and open pedicle screw placement techniques. In addition, taking the limitations of this study into consideration, it was still not appropriate to draw such a strong conclusion. More well-designed prospective randomized controlled trials are needed to assess violation rate for the 2 techniques in the future.
经皮椎弓根螺钉置入术和开放椎弓根螺钉置入术在腰椎融合手术中已被广泛应用。然而，关于这两种技术的上位小关节侵犯率的报道存在矛盾。为了更好地确定上位小关节侵犯率，本研究进行了一项系统评价和荟萃分析。我们检索了包括MEDLINE、EMBASE、科学在线和Cochrane对照试验中央注册库在内的已建立的电子文献数据库中涉及这两种椎弓根螺钉置入技术的试验。计算优势比（OR）和95%置信区间（CI）。共纳入并分析了4项比较试验，累计样本量为881例患者和1755枚上位椎弓根螺钉。结果显示，经皮组上位小关节侵犯率为18.18%（154/847），开放组为18.72%（170/908）。汇总数据显示，两组侵犯率无显著差异（OR 0.75，95%CI 0.24 - 2.30，P = 0.62）。此外，两种技术的严重侵犯率也无显著差异（OR 1.20，95%CI 0.55 - 2.62，P = 0.64，随机效应模型）。基于目前的数据，荟萃分析表明，经皮和开放椎弓根螺钉置入技术在上位小关节侵犯率方面相似。此外，考虑到本研究的局限性，得出如此强有力的结论仍不合适。未来需要更多设计良好的前瞻性随机对照试验来评估这两种技术的侵犯率。
