Rometsch Elke, Spruit Maarten, Zigler Jack E, Menon Venugopal K, Ouellet Jean A, Mazel Christian, Härtl Roger, Espinoza Kathrin, Kandziora Frank
AO Foundation, Dübendorf, Switzerland.
St Maartenskliniek, Nijmegen, Netherlands.
Global Spine J. 2020 Feb;10(1):69-88. doi: 10.1177/2192568218818164. Epub 2019 Jan 3.
Systematic literature review with meta-analysis.
Osteoporosis is common in elderly patients, who frequently suffer from spinal fractures or degenerative diseases and often require surgical treatment with spinal instrumentation. Diminished bone quality impairs primary screw purchase, which may lead to loosening and its sequelae, in the worst case, revision surgery. Information about the incidence of spinal instrumentation-related complications in osteoporotic patients is currently limited to individual reports. We conducted a systematic literature review with the aim of quantifying the incidence of screw loosening in osteoporotic spines.
Publications on spinal instrumentation of osteoporotic patients reporting screw-related complications were identified in 3 databases. Data on screw loosening and other local complications was collected. Pooled risks of experiencing such complications were estimated with random effects models. Risk of bias in the individual studies was assessed with an adapted McHarm Scale.
From 1831 initial matches, 32 were eligible and 19 reported screw loosening rates. Studies were heterogeneous concerning procedures performed and risk of bias. Screw loosening incidences were variable with a pooled risk of 22.5% (95% CI 10.8%-36.6%, 95% prediction interval [PI] 0%-81.2%) in reports on nonaugmented screws and 2.2% (95% CI 0.0%-7.2%, 95% PI 0%-25.1%) in reports on augmented screws.
The findings of this meta-analysis suggest that screw loosening incidences may be considerably higher in osteoporotic spines than with normal bone mineral density. Screw augmentation may reduce loosening rates; however, this requires confirmation through clinical studies. Standardized reporting of prespecified complications should be enforced by publishers.
系统文献综述及荟萃分析。
骨质疏松症在老年患者中很常见，这些患者经常遭受脊柱骨折或退行性疾病，且常常需要脊柱内固定手术治疗。骨质质量下降会影响螺钉的初始把持力，这可能导致螺钉松动及其后遗症，在最坏的情况下需要进行翻修手术。目前关于骨质疏松症患者脊柱内固定相关并发症发生率的信息仅限于个别报告。我们进行了一项系统文献综述，旨在量化骨质疏松性脊柱中螺钉松动的发生率。
在3个数据库中识别出关于骨质疏松症患者脊柱内固定且报告螺钉相关并发症的出版物。收集有关螺钉松动和其他局部并发症的数据。采用随机效应模型估计发生此类并发症的合并风险。使用改良的McHarm量表评估个别研究中的偏倚风险。
从1831个初始匹配项中，有32项符合条件，19项报告了螺钉松动率。各项研究在实施的手术程序和偏倚风险方面存在异质性。螺钉松动发生率各不相同，未增强螺钉报告中的合并风险为22.5%（95%置信区间10.8%-36.6%，95%预测区间[PI] 0%-81.2%），增强螺钉报告中的合并风险为2.2%（95%置信区间0.0%-7.2%，95% PI 0%-25.1%）。
这项荟萃分析的结果表明，骨质疏松性脊柱中螺钉松动的发生率可能比正常骨密度时高得多。螺钉增强可能会降低松动率；然而，这需要通过临床研究来证实。出版商应强制对预先指定的并发症进行标准化报告。
