注入骨水泥椎体成形与非手术治疗骨质疏松性椎体压缩骨折的Meta分析

Vertebroplasty injected with bone cement versus non-operative treatment for osteoporotic vertebral compression fractures:A Meta-analysis

背景:注入骨水泥椎体成形或称经皮椎体成形术作为治疗骨质疏松性椎体压缩骨折的微创技术,一些病例报道及非随机对照研究揭示了椎体成形对骨质疏松性椎体压缩骨折引起的疼痛有效。然而,这些研究主要基于回顾性的病例分析,缺乏高质量的随机对照研究。目的:通过系统评价Meta分析的方法对椎体成形术与非手术治疗骨质疏松性椎体压缩骨折的疗效进行评价。方法:计算机检索Cochrane Library(2010年第4期)、PubMed(1966/2010-11)、EMBASE(1974/2010-11)、CBM(1978/2010-11)、CNKI(1994/2010-11)、和万方数据库(1997/2010-11)。纳入椎体成形术与非手术治疗骨质疏松性椎体压缩骨折的随机对照试验,按照Cochrane Handbook5.0进行严格的质量评估,采用RevMan5.0.1软件进行Meta分析。结果与结论:共纳入4个随机对照试验,共445例患者。Meta分析结果显示,与保守治疗比较,随访1,4,24,48周时椎体成形术在缓解疼痛方面更明显,在新发骨折发生方面,两种治疗方法没有差别;与安慰剂相比,随访4周时椎体成形术在缓解疼痛、提高腰部功能活动及改善生活质量方面并无明显优势。受系统评价纳入研究数量以及质量的限制,上述结论尚需要更多高质量的随机对照试验进一步验证。

BACKGROUND： Vertebroplasty injected with bone cement or percutaneous vertebroplasty as the minimally invasive technique in treatment of osteoporotic vertebral compression fracture. Some case reports and non-randomized controlled study revealed that vertebroplasty has an effect on pain caused by osteoporotic vertebral compression fractures. However, these studies are based on retrospective case analysis, lack of high-quality randomized controlled study. OBJECTIVE： To evaluate the effectiveness of Meta-analysis method on vertebroplasty versus non-operative in treatment of osteoporotic vertebral compression fractures. METHODS： A computer-based online search of Cochrane Library （the 4th period, 2010）, PubMed database （1966/2011-11）, EMBASE database （1974/2010-11）, CBM database （1978/2010-11）, CN KI database （1994/2010-11）, and Wanfang database （1997/2010-11）. Randomized controlled trials of vertebroplasty versus non-operative in treatment of osteoporotic vertebral compression fractures were included, and underwent strict quality assessment according to Cochrane Handbook 5.0. Meta-analysis was performed by RevMan 5.0.1 software. RESULTS AND CONCLUSION： A total of 445 cases in 4 randomized controlled trials were included. Meta-analysis results showed that vertebroplasty in pain relief is more obvious than that in conservative treatment at 1,4, 24, 48 weeks follow-up, but there were no significant differences in incidence of new fracture between the two groups. Compared with the placebo, there is no significant advantage for the vertebroplasty over the placebo in pain relief, the improvement of functional activities of waist, and quality of life. The above conclusions still needs more high-quality randomized controlled trails to be verified owing to the limitations of the number and quality of systematic review included studies.