球囊椎体后凸成形术与Sky膨胀式椎体成形术治疗椎体压缩性骨折的Meta分析

Treatment effect of balloon kyphoplasty and Sky expander kyphoplasty on vertebral compression fracture:a Meta-analysis

目的评价球囊椎体后凸成形术(Pkp)与Sky膨胀式椎体成形术(Sky)治疗椎体压缩性骨折的疗效,为临床应用提供理论依据。方法通过计算机检索1995年1月-2012年10月Ovid medline、PubMed、Web of science、EMbase数据库及中国知网数据库,并手工检索相关杂志,搜集关于Pkp及Sky治疗椎体压缩性骨折疗效比较的临床随机对照研究文献。按纳入和排除标准筛选文献,采用RevMan 5.0.25对结果进行Meta分析。结果共纳入文献4篇,其中Pkp组146例,Sky组83例。随机效应模型分析显示,两种术式在恢复术后椎体前缘高度、中柱高度、矫正Cobb角和缓解患者疼痛方面的效果相似,差异无统计学意义(SMD=0.50,95%CI–0.27～1.27;SMD=0.33,95%CI–0.11～0.77;SMD=0.46,95%CI–0.74～1.66;SMD=–0.09,95%CI–0.37～0.18)。但亚组分析显示,Sky在恢复椎体前缘和中柱高度以及纠正椎体后凸角方面优于Pkp。结论 Pkp与Sky治疗骨质疏松性椎体压缩性骨折疗效无明显差异,但Sky的并发症少、医疗费用低,其临床应用效果优于Pkp。

Objective To evaluate the treatment effect of balloon kyphoplasty （Pkp） and Sky expander kyphoplasty （Sky） on vertebral compression fracture, and provide a theoretical basis for clinical application. Methods The database of Ovid medline, PubMed, Web of science, EMbase and CNKI from Jan. 1995 to Oct. 2012 were retrieved with computer, and relevant journals were manually retrieved, for the collection of the literature of therapeutic studies on treatment of vertebral compression fracture with Pkp and Sky method. The literature collected was then selected according to the inclusion and exclusion criteria, and analyzed by Meta- analysis software RevMan 5.0.25. Results A total of 4 papers were selected based on that criterion, including 146 cases of Pkp group and 83 cases of Sky group. Random effect model analysis showed no significant difference existed between the two groups regarding postoperative anterior height and column height of vertebral body, Cobb angle and pain relieve （SMD=0.50, 95%CI -0.27-1.27; SMD=0.33, 95%CI -0.11-0.77; SMD=0.46, 95%CI -0.74-1.66; SMD=-0.09, 95%CI -0.37-0.18）. However, the subgroup analysis showed the effect of Sky was better than that of Pkp on restoring anterior height and column height of vertebral body and Cobb angle. Conclusion No significant difference was found regarding the treatment effect between Pkp and Sky method in the treatment of osteoporotic vertebral compression fracture, but the clinical effect of Sky was better because of fewer complications and lower medical cost.