Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
Chongqing Medical University, Chongqing, China.
Acta Neurochir (Wien). 2023 Oct;165(10):3077-3087. doi: 10.1007/s00701-023-05721-4. Epub 2023 Jul 24.
Visual instruments are essential to ensure high-quality surgical outcomes for minimally invasive procedures and have gradually become the focus of research. Recently, a novel visual auxiliary instrument, a 3-dimensional exoscope (EX), has been applied for spinal surgery. However, its advantages over other auxiliary means (OAMs) in anterior cervical surgery need to be assessed.
To compare and evaluate the clinical outcomes of EX and OAMs in anterior cervical spine surgery using a meta-analysis and to provide the latest clinical evidence.
PubMed, Embase, Cochrane Library, Web of Science, CNKI, and Wanfang Database were systematically reviewed for relevant literature published prior to January 21, 2023. Two researchers independently screened the literature, extracted data, and assessed bias risk in the included literature. Review Manager software (version 5.4; the Cochrane Collaboration) was used to conduct the meta-analysis.
five studies, one prospective and four retrospective cohort studies, with a total of 349 patients (154 in the EX group and 195 in the OAMs group) were included. A meta-analysis showed that compared to OAMs, EX-assisted anterior cervical spine surgery resulted in less intraoperative hemorrhage [WMD = -8.96, 95% CI (-14.21, -3.71), P = 0.0008]. Nevertheless, no significant differences in VAS scores, JOA scores, operation time, hospitalization time, and complication rate were observed between the two groups (P > 0.05).
EX and OAMs are equally safe and effective for anterior cervical spine surgery; however, compared to OAMs, EX results in less intraoperative hemorrhage.
视觉仪器对于微创手术至关重要，是保证手术质量的关键，已逐渐成为研究热点。目前，一种新型的可视化辅助仪器——三维手术显微镜（EX）已应用于脊柱外科，但在颈椎前路手术中，其与其他辅助手段（OAMs）的优劣还需进一步评估。
采用荟萃分析比较和评估 EX 与 OAMs 在颈椎前路手术中的临床效果，为临床提供最新证据。
计算机检索 PubMed、Embase、Cochrane Library、Web of Science、中国知网（CNKI）和万方数据库，收集关于 EX 与 OAMs 在颈椎前路手术中应用的相关文献，检索时限均为建库至 2023 年 1 月 21 日。由 2 位研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险，采用 Review Manager 5.4 软件进行荟萃分析。
共纳入 5 项研究，均为回顾性队列研究，共 349 例患者，其中 EX 组 154 例，OAMs 组 195 例。荟萃分析结果显示，与 OAMs 相比，EX 辅助颈椎前路手术术中出血量更少[加权均数差（WMD）=-8.96，95%CI（-14.21，-3.71），P=0.0008]。但两组间视觉模拟评分（VAS）、日本骨科协会（JOA）评分、手术时间、住院时间及并发症发生率比较，差异均无统计学意义（P>0.05）。
EX 和 OAMs 用于颈椎前路手术的安全性和有效性相当，但 EX 术中出血量少于 OAMs。
