骨水泥增强技术治疗骨质疏松性椎体压缩骨折的并发症

Complications of osteoporotic vertebral compression fractures treated with bone cement enhancement technology

背景:椎体成形和椎体后凸成形是治疗骨质疏松性椎体压缩骨折的微创方法。目的:评价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安全性。方法:计算机检索Medline、EMBASE、中国知网、维普数据库、万方数据库1990年1月至2012年1月有关椎体成形和椎体后凸成形治疗骨质疏松性椎体压缩骨折并发症的文献。结果与结论:检索出62篇文献,8993例患者。椎体成形和椎体后凸成形治疗的穿刺手术并发症与其他并发症差异无显著性意义。椎体成形治疗的骨水泥渗漏率、新发骨折率高于椎体后凸成形治疗(P=0.00006,P=0.02);二者的相邻椎体骨折率差异无显著性意义。表明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严重并发症非常低,两种治疗方式相邻椎体骨折率、穿刺手术并发症及其他并发症无明显差异,但椎体后凸成形治疗后骨水泥渗漏、新发骨折率低于椎体成形治疗,此次系统评价结果尚需要大样本前瞻性研究证实。

BACKGROUND： Both vertebroplasty and kyphoplasty are minimally invasive surgeries for the treatment of osteoporotic vertebral compression fractures. OBJECTIVE： To evaluate the safety of vertebroplasty and kyphoplasty for the treatment of osteoporotic vertebral compression fractures. METHODS： A search was conducted using Medline database, EMBASE database, CNKI database, Wanfang database and VIP database from January 1990 to January 2012 for the articles on the complications after osteoporotic vertebral compression fractures treated with vertebroplasty and kyphoplasty. RESULTS AND CONCLUSION： A total of 62 studies and 8 993 patients met the inclusion criteria. There was no significant difference of puncture complications and other complications between vertebroplasty and kyphoplasty. The rates of cement leakage and new vertebral compression fractures of vertebroplasty were higher than those of kyphoplasty （P=0.000 06, P=0.02）; there was no significant difference of adjacent vertebral fractures rate between vertebroplasty and kyphoplasty. The results demonstrate that vertebroplasty and kyphoplasty are two minimally invasive methods for the treatment of osteoporotic vertebral compression fractures. There was no significant difference of adjacent vertebral fractures rate, puncture complications and other complications between vertebroplasty and kyphoplasty, but the cement leakage and new vertebral compression fractures of kyphoplasty were lower than those of vertebroplasty. So, future prospective studies with a large number of patients are needed for the systematic review.