聚醚醚酮与钛制椎间融合器用于腰椎后路椎间融合术：荟萃分析及文献综述

Polyetheretherketone Versus Titanium Cages for Posterior Lumbar Interbody Fusion: Meta-Analysis and Review of the Literature.

作者信息

Massaad Elie, Fatima Nida, Kiapour Ali, Hadzipasic Muhamed, Shankar Ganesh M, Shin John H

机构信息

Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

出版信息

Neurospine. 2020 Mar;17(1):125-135. doi: 10.14245/ns.2040058.029. Epub 2020 Mar 31.

OBJECTIVE

Lumbar fusion with implantation of interbody cage is a common procedure for treatment of lumbar degenerative disease. This study aims to compare the fusion and subsidence rates of titanium (Ti) versus polyetheretherketone (PEEK) interbody cages after posterior lumbar interbody fusion and investigate the effect of clinical and radiological outcomes following fusion on patient-reported outcomes.

METHODS

A systematic search strategy of 4 electronic databases (MEDLINE, Embase, Web of Science, and Cochrane) was conducted using different MeSH (medical subject headings) terms until January 2020. Pooled odds ratios (ORs) with 95% confidence intervals (CI) were calculated using fixed and random-effect models based upon the heterogeneity (I2) to estimate the association between interbody cages and the measured outcomes.

RESULTS

A total of 1,094 patients from 11 studies were reviewed. The final analysis included 421 patients (38.5%) who had lumbar surgery using a Ti and/or a Ti-coated interbody cage and 673 patient (61.5%) who had lumbar surgery using a PEEK cage. Overall, PEEK interbody devices were associated with a significantly lower fusion rate compared with Ti interbody devices (OR, 0.62; 95% CI, 0.41-0.93; p = 0.02). There was no difference in subsidence rates between Ti and PEEK groups (OR, 0.91; 95% CI, 0.54-1.52; p = 0.71). Also, there were no statistically significant differences in visual analogue scale (VAS)-low back pain (p = 0.14) and Japanese Orthopedic Association scale (p = 0.86) between the 2 groups. However, the PEEK group had lower odds of leg pain after surgery compared to the Ti group (OR [VAS-leg], 0.61; 95% CI, 0.28-0.94; p = 0.003).

CONCLUSION

Ti and Ti-coated PEEK cages used for posterior lumbar interbody fusion are associated with similar rates of subsidence, but a higher rate of fusion compared to PEEK interbody cages. Randomized controlled trials are needed to better assess the effect of cage materials and potential factors that could influence the outcomes of interbody lumbar fusion.

目的

腰椎椎间融合器植入融合术是治疗腰椎退行性疾病的常见手术。本研究旨在比较后路腰椎椎间融合术后钛（Ti）与聚醚醚酮（PEEK）椎间融合器的融合率及下沉率，并探讨融合后临床和影像学结果对患者报告结局的影响。

方法

采用不同的医学主题词（MeSH）对4个电子数据库（MEDLINE、Embase、Web of Science和Cochrane）进行系统检索，直至2020年1月。根据异质性（I²），使用固定效应模型和随机效应模型计算合并比值比（OR）及95%置信区间（CI），以评估椎间融合器与测量结局之间的关联。

结果

共纳入11项研究中的1094例患者。最终分析包括421例（38.5%）接受使用Ti和/或Ti涂层椎间融合器的腰椎手术患者，以及673例（61.5%）接受使用PEEK椎间融合器的腰椎手术患者。总体而言，与Ti椎间融合器相比，PEEK椎间融合器的融合率显著更低（OR，0.62；95%CI，0.41 - 0.93；p = 0.02）。Ti组和PEEK组的下沉率无差异（OR，0.91；95%CI，0.54 - 1.52；p = 0.71）。此外，两组之间视觉模拟评分法（VAS）下腰痛（p = 0.14）和日本骨科协会评分（p = 0.86）无统计学显著差异。然而，与Ti组相比，PEEK组术后腿痛的几率更低（OR[VAS - 腿痛]，0.61；95%CI，0.28 - 0.94；p = 0.003）。