Application of titanium cages and poly(ether-ether-ketone) cages in anterior cervical discectomy and fusion surgery

doi:10.3969/j.issn.2095-4344.2014.04.023

Abstract

Abstract:

BACKGROUND: The two main cages used in anterior cervical surgery are titanium cages and poly(ether-ether-ketone) cages, but it is still controversial in imaging performances and clinical outcomes.

OBJECTIVE: To systematically evaluate imaging performances and clinical outcomes between titanium cages and poly(ether-ether-ketone) cages in anterior cervical discectomy and fusion surgery.

METHODS: The Cochrane library (issue 5, 2013), Medline database, EMBASE, CNKI and Wanfang database were retrieved by computer. The deadline of all the retrieves concerning control study of uses of titanium cages and poly(ether-ether-ketone) cages was June 1^st, 2013. Two reviewers assessed literatures independently, and the meta-analysis was conducted by RevMan 5.2 software.

RESULTS AND CONCLUSION: A total of four literatures including 235 patients, 128 of titanium cages and 107 of poly(ether-ether-ketone) cages, were included. Meta-analysis results showed that there was no statistically significant difference between the groups in fusion rates, subsidence and dislocation rates of short-term follow-up and clinical outcomes (all P > 0.05). There were statistically significant differences between the groups in subsidence and dislocation rates of long-term follow-up (P < 0.05). Poly(ether-ether-ketone) cage group was superior to titanium cages group in maintenance of cervical curvature and intervertebral height. This meta-analysis showed that poly(ether-ether-ketone) cages had good fusion rates and clinical outcomes, less subsidence and dislocation rates, and can better maintain cervical curvature and intervertebral height compared with titanium cages.

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

全文链接：

Key words: cervical vertebrae, spinal fusion, titanium, evidence-based medicine

CLC Number:

R318

Duan Wen1, Kong Rong1, Huang Wei1, Zhou Ran2. Application of titanium cages and poly(ether-ether-ketone) cages in anterior cervical discectomy and fusion surgery[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(4): 625-630.

Figures/Tables 2

2.1 检索结果分析共检索出文献188篇，通过阅读文献标题及摘要，初步筛选出22篇文献可能符合纳入标准，再通过阅读全文后，最终纳入4篇研究[34-37]，均为英文文献。 2.2 基线分析及质量评价表1为纳入研究的基本情况。通过“随机方法、分配隐藏、盲法、失访/推出、选择性报告结果、其他偏倚”6个方面对纳入研究进行系统评价(表2)。 2.3 系统评价结果 2.3.1 融合率 4项研究均报道了融合率，其中3项研究对短期融合率进行比较[34-36]，1项研究为长期研究[37]。对3项短期研究进行Meta分析，其中钛笼组124个节段，聚醚醚酮组91个节段，对研究结果进行异质性分析，结果存在异质性(P=0.01， I2=78%)，因此采用随机效应模型进行分析。结果显示钛笼组与聚醚醚酮组短期融合率差异无显著性意义(P > 0.05)(图1)。在这项长期研究中钛笼组与聚醚醚酮组均达到骨性融合。 2.3.2 颈椎曲度由于纳入研究对颈椎前凸角度的指标不一，因此未进行Meta分析。Niu等[35]经过2年的随访认为术后对颈椎病变节段前凸的纠正角度钛笼组与聚醚醚酮组差异无显著性意义(P > 0.05)，在随访结束时两组颈椎病变节段前凸角度的丢失程度差异同样无显著性意义(P > 0.05)。Cabraja等[36]的研究认为钛笼组与聚醚醚酮组术后较术前颈椎曲度均有明显恢复，但两组之间术后及2年随访结束时颈椎曲度差异均无显著性意义(P > 0.05)。Chen等[37]的研究认为两组术后颈椎曲度差异无显著性意义 (P > 0.05)，7年随访后聚醚醚酮组颈椎曲度要优于钛笼组，差异有显著性意义(P < 0.05)，在颈椎曲度丢失方面，聚醚醚酮组要小于钛笼组，差异有显著性意义(P < 0.05)。 2.3.3 融合节段椎间隙高度由于纳入研究评价椎间隙高度的指标不一，因此未进行Meta分析。Niu等[35]的研究发现经过2年的随访，聚醚醚酮组术后椎间隙前缘及后缘高度的丢失要明显小于钛笼组，差异具有显著性意义(P < 0.05)。Chen等[37]的研究发现，经过7年的随访，聚醚醚酮组术后椎间隙高度的丢失要明显小于钛笼组，差异有显著性意义(P < 0.05)。 2.3.4 下沉移位率 4篇研究对椎间融合器下沉及移位均有描述，对3篇短期研究进行Meta分析[34-36]，其中钛笼组108个节段，聚醚醚酮组85个节段，对研究结果进行异质性分析，结果不存在异质性(P=0.35，I2= 4%)，因此采用固定效应模型进行分析。结果显示钛笼组与聚醚醚酮组下沉移位率差异无显著性意义(P > 0.05) (图2)。但是在这项长期研究中[11，37]结果显示聚醚醚酮组的下沉移位率要小于钛笼组，差异有显著性意义(P < 0.05)。 2.3.5 临床疗效有3项研究采用Odom标准对临床疗效进行评价[35-37]，其中2篇为短期[35-36]，1篇为长期[37]，但考虑临床疗效短期长期变化不大，因此纳入这3项研究进行Meta分析，其中钛笼组101例患者，聚醚醚酮组98例患者，对研究结果进行异质性分析，结果不存在异质性(P= 0.17，I2 = 44%)，因此采用固定效应模型进行分析。结果显示钛笼组与聚醚醚酮组的临床疗效差异无显著性意义(P > 0.05) (图3)。 "

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