摘要
背景:经皮椎体后凸成形技术和经皮椎体成形技术在治疗骨质疏松性椎体压缩性骨折方面均为有效安全的微创治疗方法,经皮椎体后凸成形技术在长期缓解疼痛、骨水泥渗漏发生率、恢复椎体高度、远期减小后凸角方面较经皮椎体成形技术有一定的优势,但是不能完全否认经皮椎体成形技术在骨质疏松性椎体压缩性骨折治疗中的效果。目的:对经皮椎体后凸成形技术,经皮椎体成形技术治疗骨质疏松性椎体压缩性骨折的安全性及有效性进行全面性Meta分析。方法:计算机搜索PubMed,Web of science,Ovid medline,Embase,Cochrane central database,CNKI等数据库,搜集建库至2013年5月份发表的所有经皮椎体后凸成形技术、经皮椎体成形技术治疗骨质疏松性椎体压缩性骨折的对照研究,2名作者根据纳入和排除标准再次独立进行筛选文献,采用Cochrane协作网提供的Revman5.2(5.2.5版本)软件进行Meta分析。结果与结论:共12个研究,1 081例患者被纳入。Meta分析结果示,经皮椎体后凸成形技术、经皮椎体成形技术在短期内缓解疼痛差异、短期及远期改善患者功能障碍的差异、相邻椎体骨折发生率的差异、短期内减小后凸角差异、手术所需时间差异均无显著性意义(P>0.05)。两种治疗方法在长期缓解疼痛差异、骨水泥渗漏发生率的差异、治疗后椎体高度恢复差异、治疗后远期改善后凸角差异有显著性意义(P<0.05)。结果可见经皮椎体后凸成形技术在长期缓解疼痛、骨水泥渗漏发生率、恢复椎体高度、远期减小后凸角方面较经皮椎体成形技术有优势,且均为安全及有效的治疗方式,因原始研究缺乏更多的高质量随机对照研究进一步论证,建议临床上慎重选择治疗方式。
BACKGROUND： Percutaneous kyphoplasty and percutaneous vertebroplasty are effective safe minimally invasive treatment methods for osteoporotic vertebral compression fracture. Percutaneous kyphoplasty has a certain advantage on long-period pain release, incidence rate of bone cement leakage, vertebral height recovery, and long-term kyphotic angle reduction compared with percutaneous vertebroplasty. However, we cannot deny the effects of percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fracture. OBJECTIVE： A meta-analysis was performed to assess the safety and efficacy of percutaneous kyphoplasty and percutaneous vertebroplasty for treating osteoporotic vertebral compression fractures. METHODS： A systematic computer-based search of all studies published till May 2013 was conducted in PubMed, Web of science, Ovid medline, Embase, Cochrane central database and CNKI for controlled studies concerning percutaneous kyphoplasty and percutaneous vertebroplasty in treatment of osteoporotic vertebral compression fracture. Study selection was done by two reviewers independently according to inclusion and exclusion criteria. Meta analysis was performed using Revman5.2（5.2.5 edition） software provided by Cochrane Collaboration. RESULTS AND CONCLUSION： A total of 12 studies containing 1 081 patients were included. The results of meta-analysis indicated that there were no significant differences between the two groups in the short-term pain relief, short-term and long-term Oswestry Dability Index scores, incidence of adjacent-level fracture, short-term restoration of kyphosis angle and operation time（P ＆gt; 0.05）. However, there were significant differences in the long-term pain relief, the incidence of cement leakage, postoperative anterior vertebral heights and long-term restoration of kyphosis angle（P 〈 0.05）. Results suggested that percutaneous kyphoplasty was superior to percutaneous vertebroplasty in the long-term pain relief, the incidence of cement leakage, restoration of postoperative anterior vertebral body and long-term restoration of kyphosis angle. Percutaneous kyphoplasty and percutaneous vertebroplasty both are safe and effective surgical procedures. Due to lack of high-quality randomized controlled trails in the original studies, more randomized controlled trails are required and a prudent choice is suggested.
出处
《中国组织工程研究》
CAS
CSCD
2014年第22期3551-3559,共9页
Chinese Journal of Tissue Engineering Research
