哪种椎间器械能最大程度地减少颈椎前路椎间盘切除术和融合术后的不愈合、下沉和再次手术?比较同种异体移植与聚醚醚酮椎间融合器的系统回顾和荟萃分析。

IF 2.9 2区 医学 Q2 CLINICAL NEUROLOGY
Chul-Ho Kim, Dong-Ho Lee, Chang Ju Hwang, Jae Hwan Cho, Sehan Park
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引用次数: 0

摘要

目的:颈椎前路椎间盘切除和融合术(ACDF)后的不愈合和明显下沉与不良的临床疗效有关,有时会导致翻修手术。同种异体移植和聚醚醚酮(PEEK)保持架是 ACDF 最常用的两种椎间隔装置。虽然已有研究对这两种椎体间架材料的功效进行了比较,但关于其中一种材料优于另一种材料的问题仍然存在。因此,作者进行了一项系统性回顾和荟萃分析,比较了使用同种异体移植材料和 PEEK 骨架作为椎体间设备进行 ACDF 后的不愈合率、下沉率和再手术率:在这项系统性综述和荟萃分析中,作者系统地检索了MEDLINE、EMBASE和Cochrane图书馆数据库中2023年11月之前发表的、比较同种异体移植和PEEK保持架用于ACDF的有效性和安全性的研究。我们设计了一项汇总分析,以确定两种椎间孔镜装置在不愈合率、下沉率和再次手术率方面的差异:结果:共纳入了 10 项研究,涉及 1462 名患者(异体移植物,852 名患者;PEEK 骨架,610 名患者)。汇总分析表明,与 PEEK 保持架相比,同种异体移植的不愈合率明显较低(OR 0.33,95% CI 0.14-0.79;P = 0.01)。此外,与同种异体骨移植相比,PEEK 骨架因骨不连导致的再手术率明显更高(OR 0.28,95% CI 0.11-0.71;P < 0.01),而因整体原因导致的再手术率则没有明显结果(OR 0.38,95% CI 0.11-1.29;P = 0.12)。明显下沉的发生率(OR 0.66,95% CI 0.28-1.55;P = 0.34)和平均下沉量(标准平均差 0.03,95% CI -0.42-0.47;P = 0.90)在同种异体移植和 PEEK 骨架之间没有显示出显著差异:总体而言,当前的荟萃分析表明,在 ACDF 中使用同种异体移植比使用 PEEK 骨架更有优势,因为同种异体移植可提高融合率,最大限度地降低翻修风险,同时不会增加下沉风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Which interbody device minimized nonunion, subsidence, and reoperation after anterior cervical discectomy and fusion? A systematic review and meta-analysis comparing allograft versus polyetheretherketone cage.

Objective: Nonunion and significant subsidence after anterior cervical discectomy and fusion (ACDF) are associated with poor clinical outcomes, which occasionally lead to revision surgery. Allograft and polyetheretherketone (PEEK) cages are the two most commonly used interbody spacer devices for ACDF. Although studies have been conducted to compare the efficacies of these two interbody materials, the question remains regarding the superiority of one over the other. Therefore, the authors conducted a systematic review and meta-analysis to compare nonunion, subsidence, and reoperation rates after ACDF using allograft and PEEK cages as interbody devices.

Methods: In this systematic review and meta-analysis, the authors systematically searched the MEDLINE, EMBASE, and Cochrane Library databases for studies published prior to November 2023 that compared the efficacy and safety of allograft and PEEK cages for ACDF. A pooled analysis was designed to identify differences in nonunion, subsidence, and reoperation rates between the two interbody devices.

Results: Ten studies involving 1462 patients (allograft, 852 patients; PEEK cage, 610 patients) were included. The pooled analysis demonstrated that allograft had a significantly lower rate of nonunion compared to that of PEEK cages (OR 0.33, 95% CI 0.14-0.79; p = 0.01). Furthermore, the reoperation rate due to nonunion was significantly higher with PEEK cages compared to that with allograft (OR 0.28, 95% CI 0.11-0.71; p < 0.01), whereas the reoperation rate due to overall causes did not display significant results (OR 0.38, 95% CI 0.11-1.29; p = 0.12). The incidence of significant subsidence (OR 0.66, 95% CI 0.28-1.55; p = 0.34) and the mean amount of subsidence (standard mean difference 0.03, 95% CI -0.42 to 0.47; p = 0.90) did not demonstrate significant differences between allograft and PEEK cages.

Conclusions: Overall, the current meta-analysis suggests the advantages of allograft over PEEK cages used for ACDF, due to an enhanced fusion rate and minimized revision risk, with no increase in the risk of subsidence.

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来源期刊
Journal of neurosurgery. Spine
Journal of neurosurgery. Spine 医学-临床神经学
CiteScore
5.10
自引率
10.70%
发文量
396
审稿时长
6 months
期刊介绍: Primarily publish original works in neurosurgery but also include studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology.
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