骨水泥椎体强化与保守治疗骨质疏松椎体压缩性骨折再骨折风险的Meta分析

The risk of subsequent vertebral fracture following cement vertebral augmentation and consecutive treatment osteoporotic vertebral compression fractures: a meta-analysis

中文关键词:  骨质疏松  椎体压缩性骨折  骨水泥椎体强化术  术后再骨折

英文关键词:Osteoporosis  Osteoporotic vertebral compressive fractures  Cement vertebral augmentation  Subsequent vertebral fracture

中文摘要:

  【摘要】 目的：对目前已发表的关于骨水泥椎体强化[包括经皮椎体成形术（PVP）和椎体后凸成形术（PKP）]与保守治疗骨质疏松椎体压缩性骨折（OVCF）的随机对照试验进行系统性评价，探讨椎体强化术后再发椎体骨折风险，为临床医疗和科研提供统计学依据。方法：通过计算机全面检索PubMed、Web of Science、Cochrane图书馆、EMBASE数据库，收集由建库至2018年4月发表的关于骨水泥椎体强化与保守治疗OVCF安全性和再发骨折的临床随机对照研究（randomized controlled trials，RCT）文献；遵循Cochrane协作网系统评价方法价纳入文献质量和可靠性，提取患者骨折椎体数、骨折平面、椎体压缩程度、骨密度以及再发椎体骨折相关数据；通过Review man 5.3软件行Meta分析，采用固定效应模型或随机效应模型合并数据，计算相对危险度（relative risk，RR）/标准化均数差（standardized mean difference，SMD）值和95%可信区间（confidence interval，CI），采用漏斗图对发表偏倚进行评估。结果：共纳入9篇文献，样本总量为853例，其中437例行椎体强化手术，416例接受保守治疗。2篇为高质量文献，5 篇为中等质量文献，2 篇为低质量文献。Meta分析结果显示：与保守治疗相比，骨水泥椎体强化术后患者再发椎体骨折的发生率[RR=1.13，95%CI（0.85，1.49），P=0.41]及相邻椎体再骨折发生率[RR=0.93，95%CI（0.48，1.82），P=0.84]均无统计学差异（P＞0.05）。结论：骨水泥椎体强化术是治疗OVCF的有效方法，不会增加再发椎体骨折的风险，再发椎体骨折可能同骨质疏松症的自然进程相关。

英文摘要:

  【Abstract】 Objective: A systematic review of published randomized controlled trials about cement vertebral augmentation[percutaneous vertebroplasty(PVP) / percutaneous kyphoplasty (PKP)] and conservative treatment of osteoporotic vertebral compression fracture(OVCF), had been conducted to investigate the risk of new vertebral fracture on postoperative patients undergoing vertebral augmentation, and to provide statistical evidence for medical care and scientific research. Methods: Databases including PubMed, Web of Science, Cochrane library, EMBASE Database were searched to collect randomized controlled trials(RCTs) about the safety and refracture after cement vertebral augmentation and conservative treatment in OVCF from inception to April 2018. Following the Cochrane Collaborative Web System Evaluation Method, the study rigorously evaluated the quality and reliability of the included literature and extracted relevant data from the researches including the number of fractured vertebral bodies, the level of vertebral fracture, the degree of vertebral compression, the bone mineral density and subsequent vertebral fractures. Then, a meta-analysis was conducted through Review man 5.3 software, and the data were pooled by using a fixed effect model or a random effect model to calculate the relative risk(RR)/ standardized mean difference(SMD) and 95% confidence interval(CI). Publication bias was determined by the funnel plot. Results: A total of 9 RCTs involving 853 cases of OVCF was included, in which 437 cases underwent vertebral augmentation and 416 cases underwent conservative treatment. According to Cochrane Handbook for Systematic Reviews, two literatures were high quality, five literatures were medium quality, two literatures were low quality. In Meta-analysis, there was no statistically significant difference between the two groups(P>0.05) in the incidence of new vertebral fracture[RR=1.13, 95%CI(0.85, 1.49), P=0.41] and incidence of adjacent vertebral refracture[RR=0.93, 95%CI(0.48，1.82), P=0.84]. Conclusions: Cement vertebral augmentation is minimally invasive treatment for OVCF, which does not increase the risk of new vertebral fracture after PVP/PKP. Its occurrence might be related to the natural procedure of osteoporosis.