摘要
目的:系统评价3D打印椎间融合器在颈椎前路椎间盘切除植骨融合术中的临床疗效与安全性。方法:通过检索PubMed、Embase、The Cochrane Library、CBM、CNKI、万方和维普数据库,收集各数据库建库至2022年4月有关颈椎前路椎间盘切除植骨融合术中置入3D打印椎间融合器(3D Cage)的临床对照试验文献,由2名独立研究者根据纳入、排除标准进行文献筛选、资料提取、质量评价,使用RevMan 5.3软件对结局指标进行Meta分析。结果:(1)共纳入11篇相关文献,其中2篇中等偏倚风险的随机对照试验文献,9篇高质量回顾性研究文献;共涉及患者691例,试验组(3D Cage置入)338例,对照组(其他植入物置入)353例;(2)Meta分析结果显示:两组在椎间融合率(RR=1.03,95%CI:0.98-1.07,P=0.23)方面比较无明显差异;在手术时间(MD=-11.84,95%CI:-17.12至-6.57,P<0.0001)、术中出血量(MD=-10.60,95%CI:-16.86至-4.33,P=0.0009)、并发症(RR=0.55,95%CI:0.35-0.88,P=0.01)、C2-7Cobb角(MD=4.14,95%CI:3.42-4.85,P<0.00001)、椎间隙高度(MD=0.48,95%CI:0.25-0.70,P<0.0001)以及亚组分析下的颈椎JOA评分(SMD=0.55,95%CI:0.29-0.82,P<0.0001;SMD=1.09,95%CI:0.73-1.46,P<0.00001)方面试验组优于对照组。结论:3D打印椎间融合器的椎间融合率不劣于其他植入物;3D打印椎间融合器能够缩短手术时间、减少术中出血、降低并发症发生;对于颈椎矢状位平衡以及神经功能恢复具有较好的促进作用。
OBJECTIVE:To systematically evaluate the clinical efficacy and safety of 3 D printed cages in anterior cervical discectomy and fusion.METHODS:PubMed,Embase,The Cochrane Library,CBM,CNKI,Wanfang,and VIP databases were searched to collect the clinical controlled trial articles on 3 D printed fusion cage(3 D Cage)placed in anterior cervical discectomy and fusion surgery from database establishment to April 2022.Two independent investigators performed literature screening,data extraction and quality evaluation according to the inclusion and exclusion criteria.Meta-analysis was performed on the outcome measures using RevMan 5.3 software.RESULTS:(1)A total of 11 relevant articles were included,containing 2 articles of randomized controlled trials with moderate risk of bias and 9 articles of highquality retrospective study.A total of 691 patients were involved,338 cases in the test group(3 D cage implantation)and 353 cases in the control group(other implant implantation).(2)Meta-analysis results showed that there was no significant difference in the fusion rate(RR=1.03,95%CI:0.98 to 1.07,P-0.23)between the two groups.The operation time(MD=-11.84,95%CI:-17.12 to-6.57,P<0.0001),intraope rative blood loss(MD=-10.60,95%CI:-16.86 to-4.33,P=0.0009),complications(RR=0.55,95%CI:0.35 to 0.88,P=0.01),C;Cobb angle(MD=4.14,95%CI:3.42 to 4.85,P<0.00001),interve rtebral space height(MD=0.48,95%CI:0.25 to 0.70,P<0.00001)and cervical JOA score under analysis(SMD=0.55,95%CI:0.29 to 0.82,P<0.0001;SMD=1.09,95%CI:0.73 to 1.46,P<0.00001)were superior in the test group to those in the control group.CONCLUSION:The fusion rate of 3 D Cage was not infe rior to other implants.3 D Cage could shorten operation time,reduce intraoperative blood loss and reduce the occurrence of complications;it co uld promote the sagittal balance of ce rvical ve rtebra and the recovery of neurological function.
作者
王彦金
周英杰
柴旭斌
禚汉杰
Wang Yanjin;Zhou Yingjie;Chai Xubin;Zhuo Hanjie(Henan University of Chinese Medicine,Zhengzhou 450046,Henan Province,China;Luoyang Orthopedic Traumatological Hospital of Henan Province(Henan Provincial Orthopedic Hospital),Luoyang 471002,Henan Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2023年第9期1434-1440,共7页
Chinese Journal of Tissue Engineering Research
基金
河南省科技攻关计划项目(182102310678),项目负责人:周英杰。
关键词
3D打印
钛合金
椎间融合器
颈椎病
颈椎间盘切除
META分析
3D printing
titanium alloy
intervertebral fusion cage
cervical spondylosis
cervical discectomy
meta-analysis
作者简介
第一作者:王彦金,男,1997年生,河南省南阳市人,蒙古族,河南中医药大学在读硕士,主要从事中医药防治脊柱相关疾病的研究,https://orcid.org/0000-0003-2230-8607;通讯作者:周英杰,硕士研究生导师,主任医师,河南省洛阳正骨医院(河南省骨科医院),河南省洛阳市471002。
