Accuracy of Sub-axial Cervical Pedicle Screw Placement：A Systematic Review with the Meta-analysis Comparing Free-hand and Assistant Techniques
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摘要:
目的 系统比较徒手与辅助技术下颈椎椎弓根螺钉（sub-axial cervical pedicle screw sCPS）置入的准确性、螺钉穿破椎弓根方向以及螺钉相关并发症。 方法 检索Medline、Embase以及Cochrane数据库，收集2010年1月至2022年12月研究不同置钉技术下颈椎椎弓根螺钉置入准确性的高质量英文文献，根据纳入标准筛选文献、数据提取，使用RevMan 5.4进行Meta分析。 结果 共纳入26项研究，1697名患者，6654颗螺钉。Meta分析示：辅助技术置入sCPS有更高的准确率。穿破椎弓根外壁比内壁更常见，徒手技术置钉穿破上壁比下壁更常见，辅助技术置钉上壁和下壁穿破率，差异暂无统计学意义。 结论 （1）辅助技术较徒手技术对于置入sCPS有更高的准确性；（2）穿破椎弓根外壁和下壁比穿破内壁和上壁更常见；（3）sCPS置入的准确性评估需要统一的评估标准；（4）不同的辅助置钉技术各有优劣，应根据实际情况选择。 Abstract:Objective To systematically compare the accuracy, direction of pedicle screw perforation, and screw-related complications of sub-axial cervical pedicle screw （sCPS） placement with and without assistant techniques. Methods A total of 26 studies involving 1697 patients and 6654 screws were included. Medline, Embase, and Cochrane databases were searched to collect the high-quality English literature on the accuracy of cervical pedicle screw （CPS） placement using different screw placement techniques from 2010.1 to 2022.12. Literature was screened according to the inclusion criteria, data was extracted, and a meta-analysis was performed using RevMan 5.4. Results The meta-analysis showed that assistant techniques had a higher accuracy rate for sCPS placement. Perforation of the lateral wall of the pedicle was more common than the medial wall, and free-hand screw placement was more common in the superior wall than the inferior wall. There was no statistically significant difference in the perforation rate between the superior and inferior walls with assistant techniques. Conclusion 1. Assistant techniques has a higher accuracy rate for sCPS placement than free-hand techniques. 2. Perforation of the lateral and inferior walls of the pedicle is more common than perforation of the medial and superior walls. 3. A unified evaluation standard is needed for assessing the accuracy of sCPS placement. 4. Different assistant screw placement techniques have their own advantages and disadvantages, and should be selected according to the actual conditions. -
Key words:
- Systematic review /
- Pediclescrew /
- Sub-axial cervical
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图 2 徒手置钉技术与辅助置钉技术准确率的Meta分析
Figure 2. Meta analysis of the accuracy of free-hand techniques vs assisted techniques
图 3 徒手置钉组穿破椎弓根内外壁的森林图
Figure 3. Forest plot of the free-hand techniques group perforation the medial and lateral walls of the pedicle
图 4 徒手置钉组穿破椎弓根上下壁的森林图
Figure 4. Forest plot of the free-hand techniques group perforation the superior and inferior walls of the pedicle
图 5 徒手置钉组穿过椎弓根内外壁的漏斗图
Figure 5. Funne plot of the free-hand techniques group perforation the medial and lateral walls of the pedicle
图 6 辅助置钉组穿破椎弓根内外壁的Meta分析
Figure 6. Meta analysis of the assisted techniques group perforation the medial and lateral walls of the pedicle
图 7 辅助置钉组穿破椎弓根上下壁的Meta分析
Figure 7. Meta analysis of the assisted techniques group perforation the superiorly and inferiorly walls of the pedicle
图 8 辅助置钉组穿过椎弓根内外壁的漏斗图
Figure 8. Funne plot of the assisted techniques group perforation the medial and lateral walls of the pedicle
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