C1侧块螺钉与C1椎弓根螺钉治疗寰枢椎失稳的临床疗效及安全性的Meta分析

Clinical Efficacy and Safety of C1 Lateral Mass Screws versus C1 Pedicle Screws in the Treatment of Atlantoaxial Instability: A Meta-Analysis

摘要: 目的：对C1侧块螺钉联合C2椎弓根螺钉与C1椎弓根螺钉联合C2椎弓根螺钉治疗寰枢椎不稳的临床疗效及安全性进行meta分析。方法：检索Cochrane图书馆、Pubmed、(EMbase)综合性生物医学文献数据库、万方数据库、中国知网、维普、CBM中国生物医学文献(SinoMed)等网络数据库。检索至2021年05月所有比较C1侧块螺钉(C1LMS)与C1椎弓根螺钉(C1PS)治疗寰枢椎不稳(C2置入椎弓根螺钉，连接棒固定)的对照试验。RCT研究的质量评价使用Cochrane风险因素评估工具，非随机回顾性对照研究用Newcastle-Ottawa scale量表评估，数据处理选用Review Manager 5.4.1统计学软件。结果：最终纳入文献共6篇，共495例患者，C1LMS组254例，C1PS组241例，纳入文献质量均较高。Meta分析研究发现：1) 两种技术在临床疗效方面无明显差异，即术后JOA评分、术后VAS评分(P > 0.05)；2) C1LMS组在手术时间、术中出血量方面明显较C1PS组增加(P < 0.0001)；3) 虽在总的并发症上并无明显差异(P > 0.05)，但C1LMS组更易损伤静脉丛及C2神经根(P < 0.006)。结论：C1LMS与C1PS治疗AAI的meta分析发现，两者的临床疗效并无太大差异，较C1LMS，C1PS在缩短手术时间、减少术中出血量、降低静脉丛和C2神经根损伤风险上更具优势。

Abstract: Objective: To conduct a meta-analysis of the clinical efficacy and safety of C1 lateral mass screws combined with C2 pedicle screws versus C1 pedicle screws combined with C2 pedicle screws in the treatment of atlantoaxial instability. Methods: Search Cochrane Library, Pubmed, Embase, Wanfang database, China Knowledge Network, Vip database, CBM. The published literature to date was collected to include all controlled trials comparing C1LMS with C1PS for atlantoaxial instability. Quality evaluation of RCT studies, using the Cochrane Risk Factor Assessment Tool. For non-randomized retrospective controlled studies, the Newcastle-Ottawa scale was used. Data analysis was performed using Review Manager 5.4.1. Ending indicator options: 1) Operation-related indicators (operation time, intraoperative blood loss); 2) Clinical efficacy indicators (JOA score after surgery, VAS score after surgery); 3) Safety-related indicators (total complications, venous plexus injury, C2 nerve root injury, cerebrospinal fluid leakage, vertebral artery injury, recurring fractures, etc.). Results: Six articles were included. 254 cases in the C1LMS group, 241 cases in the C1PS group. The quality of the included literature was relatively high. A meta-analysis found that: 1) there were no significant differences between the two surgical techniques in terms of clinical efficacy, i.e., postoperative JOA scores, postoperative VAS scores (P > 0.05). 2) The operation time and blood loss in the C1LMS group were significantly higher than those in the C1PS group (P < 0.0001); 3) There was no significant difference in the total complications between the two methods (P > 0.05), but the venous plexus and C2 nerve roots were more easily injured in the C1LMS group (p < 0.006). Conclusion: There was no significant difference between the two in terms of clinical efficacy. But in terms of security, compared with C1LMS, C1PS has more advantages in shortening the operation time, reducing intraoperative blood loss, and reducing the risk of venous plexus and C2 nerve root injury.