De Vega Brigita, Navarro Aida Ribera, Gibson Alexander, Kalaskar Deepak M
UCL Institute of Orthopaedic & Musculoskeletal Science, Division of Surgery & Interventional Science, University College London, Royal National Orthopaedic Hospital, Stanmore, London, United Kingdom.
Royal National Orthopaedic Hospital NHS Trust, Spinal Surgery Unit, Stanmore, London, United Kingdom.
Global Spine J. 2022 May;12(4):677-688. doi: 10.1177/21925682211003552. Epub 2021 Mar 18.
Systematic review and meta-analysis.
Various methods of pedicle screw (PS) placement in spinal fusion surgery existed, which can be grouped into conventional freehand (FH), modified freehand (MF), and image-guided methods (including fluoroscopy-based navigation (FL), computed tomography-based navigation (CT-nav), robot-assisted (RA), and ultrasound-guided (UG)). However, the literature showed mixed findings regarding their accuracy and complications. This review aimed to discover which method of PS placement has the highest accuracy and lowest complication rate in pediatric and adolescent spinal fusion surgery.
A comprehensive search in MEDLINE (PubMed), EMBASE (OVID), CENTRAL, and Web of Science was conducted until May 2020 by 2 independent reviewers, followed by bias assessment with ROB 2 and ROBINS-I tools and quantification with meta-analysis. Overall evidence quality was determined with GRADE tool.
Four RCTs and 2 quasi-RCTs/CCTs comprising 3,830 PS placed in 291 patients (4-22 years old) were analyzed. The lowest accuracy was found in FH (78.35%) while the highest accuracy was found in MF (95.86%). MF was more accurate than FH (OR 3.34 (95% CI, 2.33-4.79), < .00 001, = 0%). Three-dimensional printed drill template (as part of MF) was more accurate than FH (OR 3.10 (95% CI, 1.98-4.86), < .00 001, = 14%). Overall, complications occurred in 5.84% of the patients with 0.34% revision rate. Complication events in MF was lower compared to FH (OR 0.47 (95% CI, 0.10-2.15), = .33, = 0%).
Meta-analysis shows that MF is more accurate than FH in pediatric and adolescent requiring PS placement for spinal fusion surgery.
系统评价与荟萃分析。
脊柱融合手术中存在多种椎弓根螺钉（PS）置入方法，可分为传统徒手置入（FH）、改良徒手置入（MF）和影像引导方法（包括基于荧光透视的导航（FL）、基于计算机断层扫描的导航（CT-nav）、机器人辅助（RA）和超声引导（UG））。然而，文献中关于它们的准确性和并发症的研究结果不一。本综述旨在探讨在儿童和青少年脊柱融合手术中，哪种PS置入方法具有最高的准确性和最低的并发症发生率。
由2名独立审稿人在2020年5月前对MEDLINE（PubMed）、EMBASE（OVID）、CENTRAL和Web of Science进行全面检索，随后使用ROB 2和ROBINS-I工具进行偏倚评估，并通过荟萃分析进行量化。使用GRADE工具确定总体证据质量。
分析了4项随机对照试验（RCT）和2项半随机对照试验/对照临床试验（CCT），共纳入291例患者（4至22岁）的3830枚PS。FH的准确性最低（78.35%），而MF的准确性最高（95.86%）。MF比FH更准确（比值比[OR] 3.34（95%置信区间[CI]，2.33 - 4.79），P <.00001，I² = 0%）。三维打印钻孔模板（作为MF的一部分）比FH更准确（OR 3.10（95% CI，1.98 - 4.86），P <.00001，I² = 14%）。总体而言，5.84% 的患者发生并发症，翻修率为0.34%。MF组的并发症发生率低于FH组（OR 0.47（95% CI，0.10 - 2.15），P =.33，I² = 0%）。
荟萃分析表明，在需要置入PS进行脊柱融合手术的儿童和青少年中，MF比FH更准确。
