中国人群PVP术后非手术椎体骨折的危险因素

Risk factors for non-operative vertebral fractures after PVP in Chinese: a meta-analysis

中文关键词:  压缩性骨折  椎体成形术  危险因素  Meta分析

英文关键词:Compressive fracture  Vertebroplasty  Risk factors  Meta-analysis

中文摘要:

  【摘要】 目的：系统评价中国人群椎体成形术（PVP）术后非手术椎体骨折的危险因素，为临床制定非手术椎体骨折的预防控制措施提供参考。方法：检索Pubmed数据库、Embase数据库、Cochrane Library数据库、中国知网数据库（CNKI）、维普数据库（VIP）、万方数据库等，纳入1987年1月～2018年2月期间关于中国人群PVP术后非手术椎体骨折发生的危险因素的文献。纳入标准为公开发表且可提取有效数据的文献。排除标准为病理性骨折以及NOS文献质量评分＜6分的文献。2名研究员严格评价文献质量及提取文献资料。应用Revman 5．3软件统计分析提取的数据，研究指标有：性别、术前椎体骨折数量、未抗骨质疏松治疗、椎间盘骨水泥漏、BMI指数、后凸畸形矫正度、年龄、甲状旁腺素、骨密度（BMD）上述9项指标。结果：最后纳入15篇符合标准的文献，8篇中文文献，7篇英文文献，共包含3177例患者，发生PVP术后非手术椎体骨折588例。Meta分析结果显示，与中国人群PVP术后非手术椎体骨折发生相关的危险因素有：术前多个椎体骨折[OR=1.61，95%CI=（1.08，2.39），P＜0.05]、骨水泥漏入椎间盘[OR=2.44，95%CI=（1.32，4.51），P＜0.05]、术后未抗骨质疏松治疗[OR=3.47，95%CI=（2.36，5.09），P＜0.05]、女性[OR=1.36，95%CI=（1.06，1.75），P＜0.05]、高龄[WMD=0.86，95%CI=（0.10，1.62），P＜0.05]、低骨密度[WMD=-0.66，95%CI=（-1.09，-0.22），P＜0.05]、高甲状旁腺素[WMD=4.67，95%CI=（4.22，5.13），P＜0.05]，而BMI指数[WMD=-0.13，95%CI=（-1.55，1.28），P＞0.05]、后凸畸形矫正度[WMD=1.92，95%CI=（-1.16,4.99），P＞0.05]与PVP术后非手术椎体骨折的发生率无关。结论：术前多个椎体骨折、骨水泥漏入椎间盘、术后未抗骨质疏松治疗、高龄、高甲状旁腺素、女性、低骨密度是国人PVP术后非手术椎体骨折发生的危险因素。

英文摘要:

  【Abstract】 Objectives: To systematically evaluate the risk factors of non-operative vertebral fractures after vertebroplasty(PVP) in Chinese population, and to provide reference for the clinical prevention and control of non-operative vertebral fractures. Methods: Electronic databases including Pubmed, Embase, Cochrane Library, CNKI, VIP and Wanfang were searched to identity studies that assessed the risk factors of non-operative vertebral fractures after PVP in Chinese from January 1987 to February 2018. The inclusion criteria were documents published and valid data available. The exclusion criteria were pathological fracture and NOS literature quality score <6 points. Two researchers strictly evaluated the quality of literature and extracted literature. The research indicators of the data statistically analyzed and extracted by Revman 5.3 software, included: gender, number of preoperative vertebral fractures, without anti-osteoporosis treatment, bone cement leakage intervertebral disc, BMI index, kyphosis correction degree, age, parathyroid hormone, bone mineral density(BMD). Results: Fifteen articles met the criteria, including 8 Chinese articles and 7 English articles. A total of 3177 patients was included. There were 588 cases of non-operative vertebral fracture after PVP. Meta-analysis showed that the risk factors associated with non-operative vertebral fracture after PVP in Chinese population included: multiple preoperative vertebral fractures[OR=1.61, 95%CI=(1.08, 2.39), P＜0.05], bone cement leaking into intervertebral disc[OR=2.44, 95%CI=(1.32, 4.51), P＜0.05], without postoperative anti-osteoporosis treatment[OR=3.47, 95%CI=(2.36, 5.09), P＜0.05], female[OR=1.36, 95%CI=(1.06, 1.75), P＜0.05], advanced age[WMD=0.86, 95%CI=(0.10, 1.62), P＜0.05], low bone density[WMD=-0.66, 95%CI=(-1.09, -0.22), P＜0.05], high parathyroid hormone[WMD=4.67, 95%CI=(4.22, 5.13), P＜0.05], but the BMI index[WMD=-0.13, 95%CI=(-1.55, 1.28), P＞0.05] and correction degree of kyphosis [WMD=1.92, 95%CI=(-1.16, 4.99), P＞0.05] were not related to the incidence of non-operative vertebral fracture after PVP. Conclusions: Multiple preoperative vertebral fractures, bone cement leakage into intervertebral disc, postoperative unosteoporosis treatment, advanced age, correction degree of excessive kyphosis, high parathyroid hormone, female, low bone density are the risk factors for non-operative vertebral fractures after PVP in Chinese.