Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Arabi Ave, Daneshjoo Blvd, Velenjak, Tehran, 19839-63113, Iran.
School of Medicine, Capital Medical University, Beijing, China.
J Orthop Surg Res. 2020 Jul 20;15(1):272. doi: 10.1186/s13018-020-01798-0.
Systematic review and meta-analysis.
The purpose of this study was to compare the safety and accuracy of the C2 pedicle versus C2 pars screws placement and free-hand technique versus navigation for upper cervical fusion patients.
Databases searched included PubMed, Scopus, Web of Science, and Cochrane Library to identify all papers published up to April 2020 that have evaluated C2 pedicle/pars screws placement accuracy. Two authors individually screened the literature according to the inclusion and exclusion criteria. The accuracy rates associated with C2 pedicle/pars were extracted. The pooled accuracy rate estimated was performed by the CMA software. A funnel plot based on accuracy rate estimate was used to evaluate publication bias.
From 1123 potentially relevant studies, 142 full-text publications were screened. We analyzed data from 79 studies involving 4431 patients with 6026 C2 pedicle or pars screw placement. We used the Newcastle-Ottawa Scale (NOS) to evaluate the quality of studies included in this review. Overall, funnel plot and Begg's test did not indicate obvious publication bias. The pooled analysis reveals that the accuracy rates were 93.8% for C2 pedicle screw free-hand, 93.7% for pars screw free-hand, 92.2% for navigated C2 pedicle screw, and 86.2% for navigated C2 pars screw (all, P value < 0.001). No statistically significant differences were observed between the accuracy of placement C2 pedicle versus C2 pars screws with the free-hand technique and the free-hand C2 pedicle group versus the navigated C2 pedicle group (all, P value > 0.05).
Overall, there was no difference in the safety and accuracy between the free-hand and navigated techniques. Further well-conducted studies with detailed stratification are needed to complement our findings.
系统评价和荟萃分析。
本研究旨在比较 C2 椎弓根与 C2 椎板螺钉置钉的安全性和准确性，以及徒手技术与导航技术在上颈椎融合患者中的应用。
检索数据库包括 PubMed、Scopus、Web of Science 和 Cochrane Library，以确定截至 2020 年 4 月评估 C2 椎弓根/椎板螺钉准确性的所有已发表论文。两名作者根据纳入和排除标准单独筛选文献。提取与 C2 椎弓根/椎板相关的准确性率。使用 CMA 软件进行汇总准确性率估计。根据准确性率估计的漏斗图用于评估发表偏倚。
从 1123 篇潜在相关研究中，筛选出 142 篇全文文献。我们分析了来自 79 项研究的数据，这些研究涉及 4431 例患者，共 6026 例 C2 椎弓根或椎板螺钉置入。我们使用纽卡斯尔-渥太华量表（NOS）评估本综述纳入研究的质量。总体而言，漏斗图和 Begg 检验并未显示明显的发表偏倚。汇总分析显示，C2 椎弓根螺钉徒手技术的准确性率为 93.8%，C2 椎板螺钉徒手技术的准确性率为 93.7%，导航 C2 椎弓根螺钉的准确性率为 92.2%，导航 C2 椎板螺钉的准确性率为 86.2%（均，P 值<0.001）。徒手技术 C2 椎弓根与 C2 椎板螺钉置钉的准确性以及徒手 C2 椎弓根组与导航 C2 椎弓根组之间的准确性无统计学差异（均，P 值>0.05）。
总体而言，徒手技术与导航技术在安全性和准确性方面没有差异。需要进一步进行设计良好的、详细分层的研究来补充我们的发现。
