Shega Frank D, Zhang HongQi, Manini Daudi R, Tang MingXing, Liu ShaoHua
Department of Spine Surgery, Xiangya Hospital of Central South University, Changsha City 410008, Hunan Province, China.
Department of Orthopedic Surgery, Mount Meru Regional Referral Hospital, P.O Box 3092, Arusha City, Tanzania.
Adv Orthop. 2020 Sep 1;2020:8475910. doi: 10.1155/2020/8475910. eCollection 2020.
Biomechanical properties of rods determine their ability to correct spinal deformity and prevention of postoperative sagittal and coronal changes. The selection of a proper rod material is crucial due to their specific mechanical properties that influence the surgical outcome. The purpose of this study is to compare the effectiveness of cobalt chromium rods versus titanium rods for the treatment of spinal deformity by a systematic review and meta-analysis.
PubMed, EMBASE, and the Cochrane library were searched for observational and biomechanical studies comparing cobalt chromium and titanium rods in terms of correction rate, thoracic kyphosis, lumbar lordosis, incidence of rod fracture, fatigue life of contoured rod, bending stiffness of rods, and occurrence of proximal junctional kyphosis. The demographic data and mean values of outcomes of interest were extracted from each group and compared by their mean difference as an overall outcome measure. The Review Manager software (RevMan 5.3) was utilized at a 95% significance level.
Eleven eligible studies with 641 participants for 7 observational studies and 35 samples for 4 biomechanical studies were identified. There were no significant differences between cobalt chromium and titanium rods in the correction rate of spinal deformity. Postoperative thoracic kyphosis was well restored in the cobalt chromium group with statistical significance ( value = 0.009). The incidence of rod fracture was high in titanium rods compared to cobalt chromium rods with significant difference ( value = 0.0001). Proximal junctional kyphosis occurs more in the cobalt chromium group with a significant difference ( value = 0.0009). No statistical significance between two materials in terms of lumbar lordosis, fatigue of life, and bending stiffness of rods.
The cobalt chromium rod is better than titanium rod for effective correction of spinal deformity and postoperative stability of the spine. However, the use of cobalt chromium rods is associated with increased risk of proximal junctional kyphosis.
棒的生物力学特性决定了其矫正脊柱畸形以及预防术后矢状面和冠状面改变的能力。由于棒的特定力学性能会影响手术效果，因此选择合适的棒材料至关重要。本研究的目的是通过系统评价和荟萃分析比较钴铬棒与钛棒治疗脊柱畸形的有效性。
检索了PubMed、EMBASE和Cochrane图书馆，查找比较钴铬棒和钛棒在矫正率、胸椎后凸、腰椎前凸、棒断裂发生率、塑形棒疲劳寿命、棒的弯曲刚度以及近端交界性后凸发生率方面的观察性和生物力学研究。从每组中提取感兴趣的人口统计学数据和结局均值，并通过平均差值作为总体结局指标进行比较。使用Review Manager软件（RevMan 5.3），显著性水平为95%。
共纳入11项合格研究，其中7项观察性研究有641名参与者，4项生物力学研究有35个样本。钴铬棒和钛棒在脊柱畸形矫正率方面无显著差异。钴铬组术后胸椎后凸恢复良好，具有统计学意义（P值=0.009）。与钴铬棒相比，钛棒的棒断裂发生率较高，差异有统计学意义（P值=0.0001）。近端交界性后凸在钴铬组中发生率更高，差异有统计学意义（P值=0.0009）。两种材料在腰椎前凸、疲劳寿命和棒的弯曲刚度方面无统计学差异。
钴铬棒在有效矫正脊柱畸形和脊柱术后稳定性方面优于钛棒。然而，使用钴铬棒会增加近端交界性后凸的风险。
