骶 2 髂骨翼螺钉与髂骨螺钉固定骶骨盆固定术在儿童和成人患者中并发症和翻修的比较：系统评价和荟萃分析。
Comparison of Complications and Revisions After Sacral 2 Alar Iliac Screw and Iliac Screw Fixation for Sacropelvic Fixation in Pediatric and Adult Populations: Systematic Review and Meta-Analysis.
机构信息
Orthopedics Department, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Orthopedics Department, Bumrungrad International Hospital, Bangkok, Thailand.
出版信息
World Neurosurg. 2019 Dec;132:408-420.e1. doi: 10.1016/j.wneu.2019.08.104. Epub 2019 Aug 27.
OBJECTIVE
This systematic review and meta-analysis aims to assess and compare the postoperative outcomes of iliac screw (IS) fixation versus sacral 2 alar iliac (S2AI) screw fixation in the adult and pediatric populations.
METHODS
We searched all comparative studies that compared postoperative outcomes of IS and S2AI fixation techniques for pelvic fixation from the PubMed and Scopus databases up to June 23, 2019.
RESULTS
Eleven of 951 studies (N = 632 patients) were eligible; 8, 10, 5, 6, 3, 7, 2, and 2 studies were included in pooling of postoperative complications, revisions, implant failure, screw breakage, screw prominence, wound dehiscence, wound infection, visual analog scale (VAS), and ambulatory status (AS), respectively. The IS technique had a statistically significant higher chance of postoperative complications, revisions, implant failure, screw breakage, screw prominent, wound dehiscence, and wound infection by 1.89 (95% confidence interval [CI], 1.48-2.40), 1.91 (95% CI, 1.29-2.82), 2.28 (95% CI, 1.55-3.35), 3.96 (95% CI, 1.46-10.75), 6.83 (95% CI, 2.54-18.37), 4.62 (95% CI, 1.32-16.25), and 3.03 (95% CI, 1.62-5.66), respectively compared with the S2AI fixation technique. In subgroup analysis, the IS technique had a statistically significant higher chance of postoperative complications and revisions of 1.65 (95% CI, 1.25-2.16) and 1.71 (95% CI, 1.03-2.84) in pediatric populations and 2.32 (95% CI, 1.60-3.38) and 1.94 (95% CI, 1.00-3.73) in the adult populations compared with the S2AI fixation technique. IS screw fixation had a lower AS of -0.40 (95% CI, -0.76 to -0.15) than did S2AI fixation in the adult and pediatric populations. However, there was no difference in pain VAS between both groups.
CONCLUSIONS
Sacropelvic fixation with IS screw fixation had more postoperative complications and revisions and lower AS than did S2AI fixation.
目的
本系统评价和荟萃分析旨在评估和比较髂骨螺钉（IS）固定与骶骨 2 翼髂骨（S2AI）螺钉固定在成人和儿科人群中的术后效果。
方法
我们从 PubMed 和 Scopus 数据库中检索了截至 2019 年 6 月 23 日所有比较 IS 和 S2AI 固定技术用于骨盆固定的术后结果的对照研究。
结果
951 项研究中有 11 项（N=632 例患者）符合条件；分别有 8、10、5、6、3、7、2 和 2 项研究纳入了术后并发症、翻修、植入物失败、螺钉断裂、螺钉突出、伤口裂开、伤口感染、视觉模拟评分（VAS）和活动状态（AS）的汇总分析。IS 技术在术后并发症、翻修、植入物失败、螺钉断裂、螺钉突出、伤口裂开和伤口感染方面的风险显著高于 S2AI 固定技术，风险比（95%置信区间）分别为 1.89（1.48-2.40）、1.91（1.29-2.82）、2.28（1.55-3.35）、3.96（1.46-10.75）、6.83（2.54-18.37）、4.62（1.32-16.25）和 3.03（1.62-5.66）。在亚组分析中，IS 技术在儿科人群中术后并发症和翻修的风险比（95%置信区间）分别为 1.65（1.25-2.16）和 1.71（1.03-2.84），在成人人群中为 2.32（1.60-3.38）和 1.94（1.00-3.73），风险均显著高于 S2AI 固定技术。与 S2AI 固定相比，IS 螺钉固定在成人和儿科人群中的 AS 分别低-0.40（95%置信区间-0.76 至-0.15）。然而，两组之间的疼痛 VAS 没有差异。
结论
与 S2AI 固定相比，IS 螺钉固定的骶髂固定具有更多的术后并发症和翻修，以及更低的 AS。
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