单侧与双侧入路脊柱行后凸成形治疗骨质疏松性椎体压缩骨折的Meta分析

Unilateral versus bilateral kyphoplasty for osteoporotic vertebral compression fractures:A Meta-analysis

背景:椎体后凸成形明显改善了骨质疏松性椎体压缩骨折的治疗过程,但临床上对于单侧入路还是双侧入路还存在一定争议。目的:对比单侧与双侧入路脊柱后凸成形治疗骨质疏松性椎体压缩骨折的疗效。方法:全面收集椎体单侧与双侧入路脊柱后凸成形治疗骨质疏松性椎体压缩骨折的随机对照研究,由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Meta系统评价。结果与结论:共纳入5篇文献,241例患者。在止痛及骨水泥渗漏方面,两种脊柱入路差异无显著性意义(P=0.99,P=0.56);在改善后凸角度方面,双侧入路优于单侧入路(P=0.05);在手术时间方面,单侧入路优于双侧入路(P<0.00001)。表明单侧入路与双侧入路均能明显减轻疼痛,二者差异无显著性意义;二者骨水泥渗漏率差异无显著性意义;双侧入路可更好地改善脊柱后凸角度,但手术时间较长;鉴于纳入的文献质量不高,结论尚需更多设计严谨的随机对照研究加以证实。

BACKGROUND：Kyphoplasty has been shown to significantly improve the treatment of osteoporotic vertebral compression fractures;however,it is still a controversy as to whether the procedure should be done by unilateral or bilateral approach.OBJECTIVE：To compare the efficacy and safety of unilateral or bilateral kyphoplasty for the treatment of osteoporotic vertebral compression fractures.METHODS：All controlled studies of unilateral or bilateral kyphoplasty for the treatment of OVCF were identified.Two reviewers assessed the trials and extracted data independently.RESULTS AND CONCLUSION：Five studies including 241 patients met the inclusion criteria.There was no significant difference between the two groups with regard to improvement in pain and cement leakage（P=0.99,P=0.56,respectively）.Compared with unilateral kyphoplasty,kyphotic wedge angle reduction was more significant in the bilateral group（P=0.05）.The mean operation time for the unilateral group was significantly shorter than the bilateral group（P 〈0.000 01）.The results showed that both unilateral kyphoplasty and bilateral kyphoplasty can achieve satisfactory clinical and radiographic outcomes in treating osteoporotic vertebral compression fractures.Although the bilateral kyphoplasty is more efficacious in kyphotic wedge angle reduction,the operation time is longer.There is no significant difference between the two groups in the cement leakage.High-quality randomized trials are needed to confirm these.