Perna Andrea, Smakaj Amarildo, Vitiello Raffaele, Velluto Calogero, Proietti Luca, Tamburrelli Francesco Ciro, Maccauro Giulio
Department of Geriatrics and Orthopaedic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy.
Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy.
Front Oncol. 2022 Apr 4;12:884928. doi: 10.3389/fonc.2022.884928. eCollection 2022.
Surgical palliative treatment of spinal metastases (SM) could influence the quality of life (QoL) in cancer patients, since the spine represents the most common site of secondary bony localization. Traditional open posterior instrumented fusion (OPIF) and Percutaneous pedicle screw fixation (PPSF) became the main surgical treatment alternatives for SM, but in Literature there is no evidence that describes the absolute superiority of one treatment over the other.
This is a systematic review and meta-analysis of comparative studies on PPSF versus OPIF in patients with SM, conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The outcomes of interest were: complications, blood loss, infections, mortality, pain and also the Quality of Life (QoL).
There were a total of 8 studies with 448 patients included in the meta-analyses. Postoperative complications were more frequent in OPIF (odds ratio of 0.48. 95% CI, 0.27 to 0.83; p= 0.01), PPFS was associated with blood loss (odds ratio -585.70. 95% IC, -848.28 to -323.13.69; p< 0.0001) and a mean hospital stay (odds ratio -3.77. 95% IC, -5.92 to -1.61; p= 0.0006) decrease. The rate of infections was minor in PPFS (odds ratio of 0.31. 95% CI, 0.12 to 0.81; p= 0.02) whereas the occurrence of reinterventions (0.76. 95% CI, 0.25 to 2.27; p= 0.62) and the mortality rate was similar in both groups (odds ratio of 0.79. 95% CI, 0.40 to 1.58; p= 0.51). Finally, we also evaluated pre and post-operative VAS and the meta-analysis suggested that both techniques have a similar effect on pain.
The PPSF treatment is related with less complications, a lower rate of infections, a reduction in intraoperative blood loss and a shorter hospital stay compared to the OPIF treatment. However, further randomized clinical trials could confirm the results of this meta-analysis and provide a superior quality of scientific evidence.
脊柱转移瘤（SM）的外科姑息治疗可能会影响癌症患者的生活质量（QoL），因为脊柱是继发性骨转移最常见的部位。传统的开放后路器械融合术（OPIF）和经皮椎弓根螺钉内固定术（PPSF）已成为SM的主要手术治疗选择，但文献中没有证据表明一种治疗方法绝对优于另一种。
这是一项根据系统评价和Meta分析的首选报告项目（PRISMA）声明，对SM患者中PPSF与OPIF的比较研究进行的系统评价和Meta分析。感兴趣的结果包括：并发症、失血量、感染、死亡率、疼痛以及生活质量（QoL）。
Meta分析共纳入8项研究，448例患者。OPIF术后并发症更常见（优势比为0.48，95%可信区间为0.27至0.83；p = 0.01），PPSF与失血量（优势比-585.70，95%可信区间为-848.28至-323.13.69；p < 0.0001）和平均住院时间缩短（优势比-3.77，95%可信区间为-5.92至-1.61；p = 0.0006）相关。PPSF的感染率较低（优势比为0.31，95%可信区间为0.12至0.81；p = 0.02），而两组再次干预的发生率（0.76，95%可信区间为0.25至2.27；p = 0.62）和死亡率相似（优势比为0.79，95%可信区间为0.40至1.58；p = 0.51）。最后，我们还评估了术前和术后的视觉模拟评分（VAS），Meta分析表明两种技术对疼痛的影响相似。
与OPIF治疗相比，PPSF治疗的并发症更少、感染率更低、术中失血量减少且住院时间更短。然而，进一步的随机临床试验可以证实该Meta分析的结果，并提供更高质量的科学证据。
