可扩张与静态 cage 在微创腰椎椎体间融合术中的应用：系统评价与荟萃分析。
Expandable Versus Static Cages in Minimally Invasive Lumbar Interbody Fusion: A Systematic Review and Meta-Analysis.
机构信息
Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, University of Washington, Seattle, Washington, USA.
出版信息
World Neurosurg. 2021 Jul;151:e607-e614. doi: 10.1016/j.wneu.2021.04.090. Epub 2021 Apr 30.
BACKGROUND
Expandable cages for interbody fusion allow for in situ expansion optimizing fit while mitigating endplate damage. Studies comparing outcomes after using expandable or static cages have been conflicting.
METHODS
This was a meta-analysis A systematic search was performed in accordance with the Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines identifying studies reporting outcomes among patients who underwent minimally invasive lumbar interbody fusion (MIS-LIF).
RESULTS
Fourteen articles with 1129 patients met inclusion criteria. Compared with MIS-LIFs performed with static cages, those with expandable cages had a significantly lower incidence of graft subsidence (expandable: incidence 0.03, I 22.50%; static: incidence 0.27, I 51.03%, P interaction <0.001), length of hospital stay (expandable: mean difference [MD] 3.55 days, I 97%; static: MD 7.1 days, I 97%, P interaction <0.01), and a greater increase in disc height (expandable: MD -4.41 mm, I 99.56%; static: MD -0.79 mm, I 99.17%, P interaction = 0.02). There was no statistically significant difference among Oswestry Disability Index (expandable: MD -22.75, I 98.17%; static: MD -17.11, I 95.26%, P interaction = 0.15), fusion rate (expandable: incidence 0.94, I 0%; static incidence 0.92, I 0%, P interaction = 0.44), overall change in lumbar lordosis (expandable: MD 3.48 degrees, I 59.29%; static: MD 3.67 degrees, I 0.00%, P interaction 0.88), blood loss (expandable: MD 228.9 mL, I 100%; static: MD 261.1 mL, I 94%, P interaction = 0.69) and operative time (expandable: MD 184 minutes, I 95.32%; static: MD 150.4 minutes, I 91%, P interaction = 0.56).
CONCLUSIONS
Expandable interbody cages in MIS-LIF were associated with a decrease in subsidence rate, operative time and greater in increase in disc height.
背景
用于椎间融合的可扩张 cage 可在优化贴合度的同时实现原位扩张，同时减轻终板损伤。比较使用可扩张 cage 和静态 cage 后结果的研究结果存在冲突。
方法
这是一项荟萃分析，按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行了系统搜索，确定了报告接受微创腰椎椎间融合术（MIS-LIF）患者结果的研究。
结果
14 篇文章共 1129 名患者符合纳入标准。与使用静态 cage 进行的 MIS-LIF 相比，使用可扩张 cage 的患者植骨下沉的发生率明显较低（可扩张：发生率 0.03，I 2 =22.50%；静态：发生率 0.27，I 2 =51.03%，P 交互作用 <0.001），住院时间较短（可扩张：平均差值[MD]3.55 天，I 97%；静态：MD 7.1 天，I 97%，P 交互作用 <0.01），椎间盘高度增加较大（可扩张：MD-4.41 毫米，I 99.56%；静态：MD-0.79 毫米，I 99.17%，P 交互作用 =0.02）。Oswestry 残疾指数（可扩张：MD-22.75，I 98.17%；静态：MD-17.11，I 95.26%，P 交互作用 =0.15）、融合率（可扩张：发生率 0.94，I 0%；静态发生率 0.92，I 0%，P 交互作用 =0.44）、腰椎前凸总体变化（可扩张：MD3.48 度，I 59.29%；静态：MD3.67 度，I 0.00%，P 交互作用 0.88）、出血量（可扩张：MD228.9 毫升，I 100%；静态：MD261.1 毫升，I 94%，P 交互作用 =0.69）和手术时间（可扩张：MD184 分钟，I 95.32%；静态：MD150.4 分钟，I 91%，P 交互作用 =0.56）之间无统计学意义。
结论
在 MIS-LIF 中使用可扩张椎间 cage 可降低沉降率、手术时间，并增加椎间盘高度。
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