A Meta Analysis Of The Screw Placement Effect Of O-Arm Navigation And C-Arm Fluoroscopicpedicle Screw Internal Fixation

Objective: A meta analysis was conducted to explore the advantages and disadvantages of the o-arm navigation-assisted screw placement and the traditional c-arm fluoroscopic screw placement in screw fixation in terms of screw placement accuracy and efficiency,intraoperative radiation dose and postoperative complication rate.Methods: We searched the randomized controlled study and the prospective or retrospective case-control study of intraoperative O-arm three-dimensional navigation-assisted pedicle screw fixation from January 2006 to January 2020 from Pubmed,Cochrane Library,Embase,Medline,CBM,CNKI and Wanfang databases.Results: A total of 15 cases were included,including 2 randomized controlled studies,5 prospective case-control studies and 8 retrospective studies,totaling 816 patients.Analysis showed that in terms of the accuracy of screw placement(OR= 2.78,95% CI= 2.01— 3.83,P< 0.00001),the rate of poor screw placement(OR= 0.12,95% CI =0.05— 0.27,P< 0.00001),the incidence of postoperative complications(OR= 0.12,95% CI = 0.04— 0.37,P= 0.0002),intraoperative blood loss(SMD =-4.33,95% CI=-4.92— 3.7,P< 0.00001)and exposure dose(SMD = 0.02,95% CI= 0.66—1.37,P< 0.00001),the difference between o-arm 3D navigation group and c-arm fluoroscopy group are statistically significant(P< 0.05).There are no significant difference in operation time(MD = 0.19,95% CI=-0.02— 0.39,P= 0.07)(P≥ 0.05).Conclusion: Compared with traditional c-arm fluoroscopy,o-arm navigation technology used in pedicle screw internal fixation has the advantages of high screw placement accuracy,low screw dislocation rate,less intraoperative bleeding and fewer complications.Compared with the traditional c-arm fluoroscopy technology,the o-arm navigation technology does not increase significantly in the operation time,and even the operation time of the two surgical schemes is similar.Compared with traditional c-arm fluoroscopy,o-arm navigation-assisted pedicle screw fixation significantly increased the exposure dose.