椎体成形和椎体后凸成形治疗骨质疏松性椎体压缩骨折的Meta分析

背景：椎体成形和椎体后凸成形的应用越来越多,但两者的对比研究较少,而且大部分都是回顾性病例分析,缺乏系统性评价。目的：对比椎体成形和椎体后凸成形治疗骨质疏松性椎体压缩骨折的效果。方法：全面收集椎体成形和椎体后凸成形治疗骨质疏松性椎体压缩骨折的对照研究,两个研究者独立评价文献,并采集数据,在严格文献质量评价的基础上,进行系统评价。结果与结论：共纳入13篇文献,总计728例患者。在疼痛及功能评分方面,两种方法差异无显著性意义（P=0.69,0.35）;在改善后凸角度及减少骨水泥渗漏方面,椎体后凸成形优于椎体成形（P〈0.00001,0.0001）。在新发邻椎骨折方面,两种方法差异无显著性意义（P=0.41）。提示椎体成形和椎体后凸成形均能明显减轻疼痛、改善功能,但二者间无差异;椎体后凸成形可更好地改善后凸角度,并减少骨水泥渗漏;关于新发邻椎骨折,还不能得出确切结论,尚需更多设计严谨的随机对照研究加以证实。

A meta-analysis of vertebroplasty and kyphoplasty for osteoporotic vertebral compression fractures

BACKGROUND： There are more and more applications of vertebroplasty and kyphoplasty. However, studies on the comparison of them are few and most of the studies was all the retrospective case analysis with lacking systematic evaluation. OBJECTIVE： To evaluate the effect of vertebroplasty and kyphoplasty for the treatment of osteoporotic vertebral compression fractures（OVCF）. METHODS： All controlled studies of vertebroplasty and kyphoplasty for the treatment of OVCF were collected. Two reviewers assessed the quality of literatures and extracted data independently to make the systematic evaluation based on the strictly evaluated the quality of the literatures. RESULTS AND CONCLUSION： Totally 13 literatures including a total of 728 patients met the inclusion criteria. There were no significant differences of the two groups in pain and functional scores （P=0.69, 0.35）. Compared with vertebroplasty, kyphotic wedge angle reduction was more significant, and the leakage of bone cement was lower in the kyphoplasty group （P 0.000 01, 0.000 1）. For the risk of new adjacent vertebral fractures, there was no difference between the two groups （P=0.41）. Both vertebroplasty and kyphoplasty can significantly reduce pain and improve functional scores, though there is no significant differences between the two groups. Kyphoplasty can improve kyphotic wedge angle well and reduce the leakage of bone cement. The risk of new fractures can not be evaluated for lack of evidence, which need further confirmation by more randomized controlled studies which are design strictly.