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中华老年骨科与康复电子杂志 ›› 2019, Vol. 05 ›› Issue (01) : 39 -47. doi: 10.3877/cma.j.issn.2096-0263.2019.01.008

所属专题: 机器人手术 文献

Meta分析

机器人辅助椎弓根置钉治疗老年脊柱退行性疾病的Meta分析
韩鹏飞1, 张芝良2, 陈成龙2, 陈韬予2, 李晓东3, 李鹏翠2, 魏垒2, 吕智2, 卫小春2,()   
  1. 1. 046000 山西省长治市第二人民医院骨科;030001 太原,山西医科大学第二医院骨与软组织损伤修复重点实验室
    2. 030001 太原,山西医科大学第二医院骨与软组织损伤修复重点实验室
    3. 046000 山西省长治市第二人民医院骨科
  • 收稿日期:2018-04-11 出版日期:2019-02-05
  • 通信作者: 卫小春
  • 基金资助:
    国家国际科技合作专项(2015DFA33050); 国家自然科学基金青年基金(81601949)

Robot-assisted placement of pedicle screws for treatment of spine degenerative diseases: A Meta-Analysis

Pengfei Han1, Zhiliang Zhang2, Chenglong Chen2, Taoyu Chen2, Xiaodong Li3, Pengcui Li2, Lei Wei2, Zhi Lyu2, Xiaochun Wei2,()   

  1. 1. Department of Orthopaedic Surgery, Second People's Hospital of Changzhi City, Changzhi 046010, China; Key Laboratory of Bone and Soft Tissue Injury Repair, Second Hospital of Shanxi Medical University, TaiYuan 030001, China
    2. Key Laboratory of Bone and Soft Tissue Injury Repair, Second Hospital of Shanxi Medical University, TaiYuan 030001, China
    3. Department of Orthopaedic Surgery, Second People's Hospital of Changzhi City, Changzhi 046010, China
  • Received:2018-04-11 Published:2019-02-05
  • Corresponding author: Xiaochun Wei
  • About author:
    Corresponding author: Wei Xiaochun, Email:
引用本文:

韩鹏飞, 张芝良, 陈成龙, 陈韬予, 李晓东, 李鹏翠, 魏垒, 吕智, 卫小春. 机器人辅助椎弓根置钉治疗老年脊柱退行性疾病的Meta分析[J]. 中华老年骨科与康复电子杂志, 2019, 05(01): 39-47.

Pengfei Han, Zhiliang Zhang, Chenglong Chen, Taoyu Chen, Xiaodong Li, Pengcui Li, Lei Wei, Zhi Lyu, Xiaochun Wei. Robot-assisted placement of pedicle screws for treatment of spine degenerative diseases: A Meta-Analysis[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2019, 05(01): 39-47.

目的

通过Meta分析比较机器人辅助与透视引导椎弓根置钉在治疗老年脊柱退行性疾病时的准确性及安全性差异。

方法

检索2008年04月至2018年04月国内外已发表的临床对照研究。所检索的数据库包括Embase、Pubmed、中国知网、维普、万方等数据库。依据检索策略,共检索到相关文献377篇,并最终纳入10篇外文文献,1篇中文文献。提取数据后,采用Review Manager 5.3软件进行数据分析。

结果

椎弓根置钉治疗老年脊柱退行性疾病时,机器人辅助组的置钉准确度优于透视引导组(95% CI:1.38~2.43,P<0.001),机器人辅助组的不良事件发生率(95% CI:0.22~0.90,P=0.02)及翻修率(95% CI:0.17~0.91,P=0.03)均少于透视引导组,而透视引导组术中辐射强度要少于机器人辅助组(95% CI:0.09~0.89,P=0.02),余结局指标两组差异均无统计学意义。

结论

在治疗老年脊柱退行性疾病时,机器人辅助椎弓根螺钉置入较传统透视引导置入具有更高的置钉准确度、更低的不良事件发生率。虽然术中辐射强度略高于透视引导组,但是机器人辅助技术仍不失为是一种安全可靠的治疗选择。

Objective

To compare the accuracy and security between robot-assisted and fluoroscopy-guided pedicle screw placement s in the treatment of spine degenerative disease.

Methods

This study included clinical trials published both at demestic and abroad from April 2008 to April 2018. The retrieval was performed inonline databases include Embase, Pubmed, CNKI, CQVIP, Wanfang Data, etc. Based on the search strategy, a total of 377 related literatures were retrieved and 10 foreign documents and 1 Chinese document were included. After data extraction, statistical software Review manager 5.3 was used for data-analysis.

Results

It was found that when the pedicle screws were used to treat elderly patients with degenerative diseases of the spine, the accuracy of placement of the robot-assisted group was superior to that of the fluoroscopy-guided group (95% CI: 1.38-2.43, P<0.001). The robot-assisted number of adverse events (95% CI: 0.22-0.90, P=0.02) and revisions (95% CI: 0.17-0.91, P=0.03) were less than the fluoroscopy guidance group. But fluoroscopy exposure was more than the robot-assisted group (95% CI: 0.09-0.89, P=0.02). Other differences between the two groups were not statistically significant.

Conclusions

In the treatment of elderly degenerative diseases of the spine, robot-assisted pedicle screw implantation has higher accuracy and fewer complications than conventional fluoroscopy guided. Although intraoperative fluoroscopy exposure is slightly higher the fluoroscopy-guided group, robot-assisted technology is still a safe and reliable treatment option.

图1 文献筛选流程图
表1 纳入文献研究基本特征表
图2 机器人辅助和透视引导椎弓根置钉治疗老年脊柱疾病准确度的Meta分析
图6 机器人辅助和透视引导椎弓根置钉治疗老年脊柱疾病术中透视时间的Meta分析
图10 机器人辅助和透视引导椎弓根置钉治疗老年脊柱疾病住院时间的Meta分析
图16 术后背部VAS评分发表偏倚漏斗图
图19 住院时间发表偏倚漏斗图
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