腰椎后路融合术后融合器沉降危险因素的Meta分析  

A Meta-analysis of risk factors associated with cage subsidence after posterior lumbar interbody fusion

作　　者：陈双 吴奂汐 王楠 谢林[3] CHEN Shuang;WU Huanxi;WANG Nan;XIE Lin(The Third Clinical Medical College of Nanjing University of Chinese Medicine,Nanjing 210029,Jiangsu,China;The Second Clinical Medical College of Nanjing University of Chinese Medicine,Nanjing 210029,Jiangsu,China;Nanjing Integrated Traditional Chinese and Western Medicine Hospital,Nanjing 210028,Jiangsu,China)

机构地区：[1]南京中医药大学第三临床医学院,江苏南京210029 [2]南京中医药大学第二临床医学院,江苏南京210029 [3]南京中医药大学附属中西医结合医院,江苏南京210028

出　　处：《中医正骨》2022年第10期44-52,共9页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：江苏省中医药科技发展计划项目(ZD202008)。

摘　　要：目的:探讨腰椎后路融合术后融合器沉降的危险因素。方法:应用计算机检索中国知网、万方数据库、维普网、中国生物医学文献数据库、PubMed、Embase、Cochrane Library中有关腰椎后路融合术后融合器沉降危险因素分析的文献,检索时限均为建库至2022年3月。按照纳入和排除标准筛选文献,采用纽卡斯尔-渥太华量表进行文献质量评价,提取数据后使用RevMan5.3软件进行Meta分析。结果:共检索到822篇文献,最终纳入10篇文献。Meta分析结果显示,年龄、骨质疏松、椎间隙高度矫正值、节段性前凸角矫正值、融合器位于椎间隙后部均为腰椎后路融合术后融合器沉降的危险因素[MD=2.97,95%CI(1.86,4.08),P=0.000;OR=5.15,95%CI(3.08,8.60),P=0.000;MD=-0.42,95%CI(-0.77,-0.06),P=0.020;MD=1.84,95%CI(1.39,2.29),P=0.000;OR=1.93,95%CI(1.09,3.42),P=0.020];女性、体质量指数、合并腰椎滑脱症、融合器长度≥24mm、融合器高度≥12mm、手术节段为L_(5)S_(1)、融合节段≥2节段,与腰椎后路融合术后融合器沉降的关联无统计学意义[OR=1.07,95%CI(0.80,1.42),P=0.670;MD=0.13,95%CI(-0.30,0.55),P=0.560;OR=1.20,95%CI(0.84,1.73),P=0.320;OR=0.75,95%CI(0.38,1.48),P=0.410;OR=1.08,95%CI(0.60,1.95),P=0.790;OR=1.25,95%CI(0.90,1.74),P=0.180;OR=1.80,95%CI(0.93,3.51),P=0.080]。描述性分析结果显示,术中损伤终板是腰椎后路融合术后融合器沉降的危险因素。基于年龄的发表偏倚分析结果提示,存在发表偏倚的可能性较小。结论:年龄、骨质疏松、椎间隙高度矫正值、节段性前凸角矫正值、融合器位于椎间隙后部、术中损伤终板是腰椎后路融合术后融合器沉降的危险因素。Objective:To investigate the risk factors associated with cage subsidence after posterior lumbar interbody fusion(PLIF).Methods:The research articles about risk factors associated with cage subsidence after PLIF were retrieved from CNKI,Wanfang Data, VIP,SinoMed, PubMed, Embase, and Cochrane Library from database inception to March 2022,and screened out according to inclusion and exclusion criteria.The Newcastle-Ottawa Scale was used to evaluate the literature quality, and RevMan 5.3 software was used for Meta-analysis after data extraction.Results:A total of 822 research articles were obtained, and 10 were finally included.As revealed by Meta-analysis, age, osteoporosis, correction value of intervertebral space height, correction value of segmental lordosis, and cage in the posterior intervertebral space were risk factors leading to cage subsidence after PLIF(MD=2.97,95%CI(1.86,4.08),P=0.000;OR=5.15,95% CI(3.08,8.60),P=0.000;MD=-0.42,95%CI(-0.77,-0.06),P=0.020;MD=1.84,95%CI(1.39,2.29),P=0.000;OR=1.93,95%CI(1.09,3.42),P=0.020).Female, body mass index, combined lumbar spondylolisthesis, cage length of≥24 mm, cage height of≥12 mm, L_(5)S_(1) fusion surgery, and number of fusion segments of≥2 were not significantly associated with cage subsidence after PLIF(OR=1.07,95%CI(0.80,1.42),P=0.670;MD=0.13,95%CI(-0.30,0.55),P=0.560;OR=1.20,95%CI(0.84,1.73),P=0.320;OR=0.75,95%CI(0.38,1.48),P=0.410;OR=1.08,95%CI(0.60,1.95),P=0.790;OR=1.25,95%CI(0.90,1.74),P=0. 180;OR = 1. 80,95% CI( 0. 93,3. 51),P = 0. 080). The results of descriptive analysis indicated that intraoperative endplate injury also served as a risk factor for cage subsidence after PLIF. The analysis of publication bias based on age suggested that there was less potential for publication bias. Conclusion: Age,osteoporosis,correction value of intervertebral space height,correction value of segmental lordosis,cage in the posterior intervertebral space,and intraoperative endplate injury were all risk factors resulting in cage subsidence after PLIF.

关 键 词：脊柱融合术 腰椎 融合器沉降 危险因素 专题Meta分析 

分 类 号：R687.3[医药卫生—骨科学]