经皮穿刺椎体成形术治疗脊柱肿瘤疗效及安全性的Meta分析

Efficacy and Safety of Percutaneous Vertebroplasty Treatment of Spinal Tumors: A Meta- analysis

目的评价经皮穿刺椎体成形术(PVP)治疗脊柱肿瘤的疗效及安全性。方法计算机检索PubMed、Cochrane library、中国知网(CNKI)、中国生物医学文献数据库(CBM)、万方科技期刊全文数据库及维普中文科技期刊数据库(VIP)中有关PVP治疗脊柱肿瘤的研究。采用RevMan 5.2软件对各项研究的疼痛强度视觉模拟评分(VAS)、疼痛缓解率、功能状态恢复率、生存率、经济效益(住院费用及时间)进行分析。结果共纳入9篇随机对照试验,1 022例患者,文献质量较低。Meta分析结果显示,试验组(PVP组)与对照组(其他治疗方式,包括开放性手术、化疗、椎体后凸成形术等)治疗脊柱肿瘤后,VAS差异无统计学意义(P=0.33);两组功能状态恢复率及并发症发生率比较,差异无统计学意义(P=0.38;P=0.85)。但对于疼痛缓解率、生存率以及经济效益(包括住院费用、住院时间),试验组明显优于对照组(P<0.05)。结论 PVP治疗脊柱肿瘤止痛效果佳,经济效益好,生存率较高。但文中部分观察指标临床报道较少,Meta分析结果尚缺乏说服力,结论需更多设计严谨的研究加以证实。

Objective To evaluate the efficacy and safety of Percutaneous vertebroplasty for spinal tumors. Methods We searched for articles about the researches on the treatment of spinal tumors by PVP in PubMed,CBM,CNKI,Wanfang full- text database and VIP. RevMan 5. 2 was used to analyze pain intensity visual analogue scale（ VAS）,pain relief,function recovery,survival rate,economic benefits（ hospital cost and length of stay） within each research. Results 9 randomized control trials were included in the study with a total of 1 022 cases of patients. The literature quality was low. Meta- analysis showed that：after treatment of spinal tumors by PVP（ in the experimental group） and other treatments including open surgery,chemotherapy,kyphoplasty（ in the control group）,VAS all had obvious improvement but no statistic significance in effectiveness was found between the two groups（ P = 0. 33）; no significant differences in function recovery and complication rates were found between the experimental group and the control group（ P = 0. 38; P = 0. 85）. But in terms of pain relief,survival and economic benefits（ including hospital costs,length of stay）,PVP group was better than the control group,with significant difference（ P 〈0. 05）.Conclusion PVP treatment of spinal tumors has a good analgesic effect with better pain relief,satisfying economical results,and higher survival rate. However,clinical reports about the observed indexes are not enough,so meta- analysis is still lack of convincingness and more strict studies are needed to prove the results.