Orthopedics Department, Tian Jin 4th Center Hospital, Tianjin, 300000, China.
Arch Orthop Trauma Surg. 2019 Oct;139(10):1329-1337. doi: 10.1007/s00402-019-03164-0. Epub 2019 Mar 15.
For odontoid fractures, surgical treatment approaches including anterior odontoid screw fixation approach and the posterior C1-C2 arthrodesis approach are generally adopted in practice. However, the choice of different surgical procedures remains controversial. In addition to surgical technique, the fusion rate is an important factor contributing to the clinical efficacy. Therefore, this study was aimed to investigate the discrepancy in fusion rate between these two surgical approaches through synthesizing the currently available evidence on the topic.
A computerized search of Ovid, Medline, Embase, and the Cochrane library up to December 2017 for literature on the complication rate during odontoid fracture treatment was conducted. Risk ratio (RR) with its 95% confidence interval (CI) was pooled to assess fusion rates after surgical treatments, including anterior odontoid screw fixation approach or posterior C1-2 arthrodesis procedure, for patients with odontoid fractures.
Thirteen studies were enrolled in the meta-analysis. Results show that no significant difference was found in the overall fusion rate (RR = 0.96, 95% CI 0.90-1.01). There was no significant heterogeneity among the studies (p value = 0.60). As to age- and economic-level subgroups, there was no statistical evidence to suggest an association of the patient age and economy development level with the choice of surgical approach. However, it is shown that better fusion rates of patients (≥ 60 years) in developed countries received a better fusion rates after posterior fixation compared with anterior group using the fixed-effect model (RR = 0.88, 95% CI 0.79-0.98).
Elderly patients (≥ 60 years) underwent posterior C1-2 arthrodesis fixation shows higher fusion rates in developed countries comparing with patients who underwent anterior odontoid screw fixation. Overall, there is no significant discrepancy between these two surgical approaches. However, the conclusion should be verified by further study enrolling larger sample size.
对于齿状突骨折，临床上通常采用前路齿状突螺钉固定术和后路 C1-C2 关节融合术两种治疗方法。但是，不同手术方法的选择仍存在争议。除了手术技术外，融合率也是影响临床疗效的一个重要因素。因此，本研究旨在通过综合目前关于该主题的可用证据，探讨这两种手术方法在融合率方面的差异。
计算机检索 Ovid、Medline、Embase 和 Cochrane 图书馆，检索时限均为 2017 年 12 月，收集有关齿状突骨折治疗过程中并发症发生率的文献。采用风险比（RR）及其 95%置信区间（CI）来评估齿状突骨折患者接受前路齿状突螺钉固定术或后路 C1-2 关节融合术治疗后的融合率。
共纳入 13 项研究进行荟萃分析。结果显示，两种手术方法的总体融合率无显著差异（RR=0.96，95%CI 0.90-1.01）。各研究之间无显著异质性（p 值=0.60）。在年龄和经济水平亚组中，患者年龄和经济发展水平与手术方法的选择之间没有统计学关联的证据。然而，研究结果表明，在发达国家，年龄较大（≥60 岁）的患者采用后路固定的融合率优于前路组（RR=0.88，95%CI 0.79-0.98）。
在发达国家，年龄较大（≥60 岁）的患者采用后路 C1-2 关节融合术固定的融合率高于采用前路齿状突螺钉固定的患者。总体而言，这两种手术方法之间没有显著差异。但是，该结论需要进一步开展纳入更大样本量的研究来验证。
