经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折远期并发症的Meta分析

Long-term complications of percutaneous kyphoplasty for osteoporotic vertebral compression fractures: a Meta-analysis

中文关键词:  骨质疏松  椎体压缩骨折  经皮椎体后凸成形术  随机对照试验  Meta分析

英文关键词:Osteoporosis  Vertebral compression fractures  Percutaneous kyphoplasty  Randomized controlled trial  Meta-analysis

中文摘要:

  【摘要】 目的：应用Meta分析评价经皮椎体后凸成形术（PKP）治疗骨质疏松性椎体压缩骨折（OVCF）的远期并发症，为临床应用提供依据。方法：计算机检索CNKI、CBM、PubMed、The Cochrane Library（2017 年第2期）、Wiley Online Library、ELSEVIER Science Direct（SDOS）数据库，检索时间均是从建库到2017年2月。收集PKP与保守治疗OVCF的相关随机对照试验（RCT）文献，经X线、CT及MRI确定诊断为胸腰椎压缩骨折；骨密度测量仪测量确定存在胸腰椎骨质疏松（T≤－2.5）；年龄≥50岁，病程＜6个月；术后结局指标至少包括以下指标中的一项：新发椎体骨折、邻近节段椎体骨折、严重并发症、视觉模拟评分。参考Cochrane系统评价手册5.0.1提供的针对随机对照试验的评价标准对纳入文献质量进行评价。结果：共纳入5篇RCT研究，4篇为英文文献，1篇为中文文献，方法学质量评价4篇文献为4分及以上，1篇文献为3分。PKP组共计417例，保守治疗组共计458例。Meta分析结果显示，PKP组治疗后3~6个月视觉模拟评分（VAS）与保守治疗组相比有统计学意义[MD=-0.36，95%CI（-0.65，-0.07），P=0.02]；在新发椎体骨折、邻近节段椎体再发骨折、严重并发症三个方面PKP组与保守治疗组无统计学差异。结论：应用PKP治疗OVCF可以降低患者疼痛VAS评分，并且不会提高新发椎体骨折、邻近节段椎体再发骨折、严重并发症的发生风险。

英文摘要:

  【Abstract】 Objectives: To evaluate the long-term complications of percutaneous kyphoplasty(PKP) for osteoporotic vertebral compression fractures(OVCF), and to provide evidence for clinical procedure. Methods: Databases including CNKI, CBM, PubMed, The Cochrane Library(Issue 2, 2017), Wiley Online Library, ELSEVIER Science Direct(SDOS) were used to collect the randomized controlled trials(RCTs) which compared PKP with conservative treatment in the treatment of OVCF from inception to February 2017. The diagnosis of thoracolumbar vertebral compression fracture was confirmed by X-ray, CT and MRI. The presence of thoracolumbar osteoporotic T which was less than or equal to -2.5, was confirmed by bone mineral density measurement. All the patients were 50 years or older, and disease duration was less than 6 months; postoperative outcomes included at least one of the following indicators: new vertebral fractures, adjacent fractures, serious adverse events, visual analogue score. Cochrane system evaluation manual 5.0.1 was referred to evaluate the quality of the included literatures. Results: Five RCT studies included four English literatures and one Chinese literature. Methodological quality assessment of 4 articles were more than or equal to 4 points, one article scored 3 points. PKP group consisted of 417 cases, conservative treatment group of 458 cases. The results of meta-analysis showed that there was statistical difference in VAS between the two groups after 3 to 6 months′ treatment(mean difference=-0.36; 95%CI -0.07 to -0.65; P=0.02). However, there was no statistical difference in new vertebral fractures, adjacent fractures or serious adverse events. Conclusions: Application of PKP in OVCF can reduce the patients′ long-term(3-6 months) VAS pain score and does not increase the risks of new vertebral fractures, adjacent fractures and serious adverse events.