椎体强化术治疗骨质疏松性椎体压缩骨折临床疗效的meta分析

Meta-analysis of the Curative Effect of Percutaneous Vertebral Augmentation on Osteoporotic Vertebral Compression Fractures

目的:探讨椎体强化术(Percutaneous Vertebral Augmentation,PVA,包括经皮椎体成形术PVP和经皮椎体后凸成形术PKP)的临床疗效。方法:通过检索PubMed和Cochrane Library数据库,收集了6个随机对照临床试验进行meta分析,有效性的评价指标包括疼痛改善、RDQ评分及EQ-5D评分改善、椎体再骨折的发生率。结果:共有7篇研究符合标准,涉及6个RCT试验,共计879例患者被纳入分析,其中椎体强化术组445例,保守治疗组434例。椎体强化术(VA)与保守治疗比较:前者术后疼痛改善[MD=1.48,95%CI(1.32,1.64)]、术后EQ-5D评分改善[MD=0.03,95%CI(0.01,0.05)]显著地优于后者,椎体再发骨折的发生率[OR=0.87,95%CI(0.40,1.87)]及术后RDQ评分改善[MD=0.22,95%CI(-1.49,1.93)]的比较差异无统计学意义。结论:椎体强化术可以更好地缓解疼痛,患者生活质量更高,术后椎体再骨折的风险与保守治疗类似。

To evaluate the clinical effects of percutaneous vertebral augmentation （PVA） ,inclnding percutaneous vertebroplasty （PVP）, and percutaneous kyphoplasty （PKP）. Methods：Six randomized controlled clinical trials were col- lected for meta-analysis by searching Pubmed database and Cochrane Library. The evaluation criteria of efficacy contain VAS, EQ-5D scores, RDQ scores, and the incidence of refractures. Results：Seven articles about 6 clinical trials were in- cluded, containing 879 patients with 445 in VA group and 434 in conservative treatment group. Compared to conservative treatment, VA treatment showed a significant improvement in pain relief[EMD= 1.48, 95%CI （1.32, 1.64）]] and EQ-SD scores after operation [MD=0.03, 95 %CI （0.01, 0.05）17, but no statistical difference in RDQ scores improvement after operation[MD=O. 22, 95%CI （-1.49, 1.93）]] and incidence of refracture [OR=0.87, 95%CI （0.40, 1.87） ]]. Conclu- sion：Vertebral augmentation could bring patients better pain relief and higher quality of life. Meanwhile, the risk of refrac- ture is similar comparing with conservative treatment.