Meta-analysis of anterior screw fixation versus posterior cervical fusion in treatment of odontoid fractures

doi:10.3969/j.issn.2095-4344.2016.48.021

Abstract

Abstract:

BACKGROUND: Many studies concern the comparison of anterior screw fixation and posterior cervical fusion for odontoid fractures, but the sample size of many studies has limitations. There is lack of objective evaluation on advantages and disadvantages of two surgical methods.

OBJECTIVE: This is a meta-analysis to compare the clinical results between anterior screw fixation versus posterior cervical fusion for odontoid fractures.

METHODS: A systematic search of all the studies published was conducted on the PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), EMbase, the ISI Web of Knowledge Database, CNKI, VIP, CMB and Wanfang databases. Randomized and non-randomized controlled trials that compared between anterior and posterior approaches for odontoid fracture were identified from database foundation to March 1, 2016. The references were also searched by hand. Meta-analyses were performed by using the Rev-Man 5.3 software, provided by the Cochrane Collaboration.

RESULTS AND CONCLUSION: (1) Twelve studies involving 514 patients were included. Among the patients, 287 underwent anterior approach and 227 underwent posterior approach. (2) The results of the meta-analysis indicated that, compared with posterior approach, anterior approach has advantages of less blood loss, shorter operative time, and a small degree of cervical rotation injury (P < 0.05). No statistical difference was determined in bone union and complication rate (P > 0.05). (3) These results suggested that both anterior and posterior approaches were demonstrated to be effective for odontoid fractures. Anterior screw fixation had obvious advantages: less bleeding, short operating time, small trauma and less spine injury. Thus, it is an ideal procedure to treat odontoid fractures. However, the operative approach should be chosen individually in clinical work.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Cervical Vertebrae, Fractures, Bone, Internal Fixators, Meta-Analysis, Tissue Engineering

CLC Number:

R318

Zha Yuan-yu, Yang Yang, Zhou Yi-chi, Wei Ren-xiong, Zhang Shu-wei, Jin Wei. Meta-analysis of anterior screw fixation versus posterior cervical fusion in treatment of odontoid fractures[J]. Chinese Journal of Tissue Engineering Research, 2016, 20(48): 7288-7296.

Figures/Tables 4

2.2.4 术后颈椎旋转度 3篇文献报道了术后颈椎旋转度情况[10-12]，各研究间存在异质性(P=0.01，I2=87%)，采用随机效应模型。Meta分析结果显示，2组差异有显著性意义[SMD =4.13，95%CI(2.52，5.74)，Z=5.03，P < 0.000 1]，提示前路手术术后颈椎旋转度较后路手术大，再以纳入研究类型的不同进行亚组分析，结果显示随机对照试验亚组各研究异质性降低(P=0.63，I2=0%)。随机对照试验亚组显示，术后颈椎旋转度差异有显著性意义[SMD=4.96，95%CI(3.8，6.11)，Z=8.41，P < 0.000 01]。敏感性分析发现分别剔除各项研究，合并效应量仍都具有统计学意义且森林图结果方向均未发生改变，见图4。2.2.5 手术并发症 5篇文献报道了术后并发症情况[6，9-10，12，16]，报道的并发症包括伤口脂肪液化、伤口感染、声嘶、咽痛、枕大神经痛、枕部压疮、颈部僵硬、神经损伤等，各研究间异质性好(P=0.35，I2=10%)，采用固定效应模型。Meta分析结果显示，2种修复方式术中并发症发生率差异无显著性意义[RR=1.09，95%CI (0.68，1.74)，Z=0.36，P > 0.05]。本研究再以纳入研究类型的不同进行亚组分析，结果显示，随机对照试验亚组各研究无异质性(P=0.71，I2=0%)；非随机对照试验亚组各研究异质性上升(P=0.18，I2=42%)，仍可认为异质性好。再以患者平均年龄是否< 65岁进行亚组分析，结果显示平均年龄< 65岁亚组中，各研究无异质性 (P=0.53，I2=0%)。平均年龄≥ 65岁亚组中，各研究间存在异质性(P=0.07，I2=70%)，Meta分析结果显示，2种修复方式术中并发症发生率差异无显著性意义[RR= 1.19，95%CI(0.55，2.55)，Z=0.44，P > 0.05]。敏感性分析发现分别剔除各项研究，合并效应量仍都具有统计学意义且森林图结果方向均未发生改变，见图5。"

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