磁力控制生长棒与其他基于牵引的脊柱侧凸早期治疗技术的比较：系统评价和荟萃分析。
Comparison of Magnetically Controlled Growing Rods with Other Distraction-Based Surgical Technologies for Early-Onset Scoliosis: A Systematic Review and Meta-Analysis.
机构信息
Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
Division of Orthopaedics, Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
出版信息
JBJS Rev. 2021 Jan 20;9(1):e20.00062. doi: 10.2106/JBJS.RVW.20.00062.
BACKGROUND
Severe and progressive early-onset scoliosis (EOS) has a serious prognosis including cardiopulmonary compromise. Growth-friendly technologies are the current surgical standard of care. Magnetically controlled growing rods (MCGRs) are newer implants with the potential for better quality of life and cost savings; however, they have not been well compared with the traditional distraction-based implants. The objective of this study was to compare the surgical outcomes, complications, metal ion levels, quality-of-life outcomes, and cost of MCGRs with other distraction-based surgical technologies for the treatment of EOS.
METHODS
The MEDLINE, Embase, and Web of Science databases were searched. Record screening and data abstraction were completed in duplicate. Summary outcomes were calculated in a meta-analysis, if heterogeneity was appropriate, using a fixed-effects model.
RESULTS
This systematic review and meta-analysis included 18 studies. MCGRs were as clinically effective as other distraction-based technologies, with no significant difference in the Cobb angle at the latest follow-up (mean difference [MD], 1.20°; 95% confidence interval [CI], -1.80° to 4.20°; p = 0.43) and a significantly lower complication rate (odds ratio, 0.42; 95% CI, 0.25 to 0.71; p = 0.001). Quality of life measured using the EOSQ-24 (24-Item Early-Onset Scoliosis Questionnaire) was better in the MCGR group compared with other technologies (MD, 2.18; 95% CI, 0.40 to 3.95; p = 0.02). Serum titanium levels were 2.98 ng/mL (95% CI, 1.41 to 4.55 ng/mL; p = 0.0002) greater in patients with MCGRs, but the clinical impact is unclear. MCGRs had greater cost for the device and insertion but became cost-neutral or cost-effective compared with other technologies by 4 years postoperatively.
CONCLUSIONS
MCGRs are clinically equivalent and cost-effective in the long term compared with other distraction-based technologies for the treatment of EOS.
LEVEL OF EVIDENCE
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
背景
严重且进展迅速的早发性脊柱侧凸（EOS）具有严重的预后，包括心肺功能受损。生长友好型技术是目前的手术标准。磁控生长棒（MCGRs）是一种新型植入物，具有改善生活质量和节省成本的潜力；然而，它们与传统的撑开式植入物相比，还没有得到很好的比较。本研究的目的是比较 MCGRs 与其他撑开式手术技术治疗 EOS 的手术结果、并发症、金属离子水平、生活质量结果和成本。
方法
检索 MEDLINE、Embase 和 Web of Science 数据库。记录筛选和数据提取均由两人完成。如果异质性合适，则使用固定效应模型进行荟萃分析计算汇总结果。
结果
本系统评价和荟萃分析纳入了 18 项研究。MCGRs 与其他撑开式技术一样具有临床疗效，在末次随访时 Cobb 角无显著差异（平均差值 [MD]，1.20°；95%置信区间 [CI]，-1.80°至 4.20°；p = 0.43），并发症发生率显著降低（比值比，0.42；95%CI，0.25 至 0.71；p = 0.001）。使用 EOSQ-24（24 项早发性脊柱侧凸问卷）测量的生活质量在 MCGR 组优于其他技术（MD，2.18；95%CI，0.40 至 3.95；p = 0.02）。MCGR 组患者的血清钛水平为 2.98ng/mL（95%CI，1.41 至 4.55ng/mL；p = 0.0002），但临床影响尚不清楚。MCGRs 设备和插入的成本较高，但在术后 4 年内与其他技术相比具有成本中性或成本效益。
结论
与其他撑开式技术相比，MCGRs 在治疗 EOS 方面具有长期的临床等效性和成本效益。
证据水平
治疗性 III 级。请参阅作者说明以获取完整的证据水平描述。
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