PVP和PKP治疗老年骨质疏松椎体压缩性骨折的Meta分析

PKP compared with PVP for OVCFs in the elderly: a systematic review

目的比较经皮椎体成形术(PVP)和经皮椎体后凸成形术(PKP)治疗老年骨质疏松椎体压缩性骨折的临床疗效。方法计算机检索在2014年5月之前在CBM、CNKI、万方、维普中文数据库、EMBASE、MEDLINE、Cochrane图书馆中公开发表的所有PVP和PKP治疗老年骨质疏松椎体压缩性骨折的随机对照研究和临床对照实验,由两位评价员按Cochrane协作网标准逐个进行质量评价,对符合纳入标准的研究用Rev Man 5.2.2进行统计分析。结果共纳入9篇文献,Meta分析结果显示PKP和PVP两组在术中骨水泥渗漏率、术后椎体前缘高度、术后cobb角及手术前后cobb角变化值四个方面有统计学意义(P<0.05),在远期再发骨折率方面无统计学意义(P>0.05)。结论 PKP较PVP在治疗老年椎体压缩性骨折方面好,但仍需大样本、多中心随机对照研究进一步证实。

Objective To compare the clinical effects between PKP with PVP for OVCFs in elderly patients. Methods We searched for data of all the randomized controlled trials and the clinical controlled trials of PKP and PVP for OVCFs in elderly patients by computer in CBM（ up to 5,2014）,CNKI（ up to 5,2014）,WANFANG（ up to 5,2014）,VIP（ up to 5,2014）,EMBASE（ up to 5,2014）MEDLINE（ up to 5,2014）,Cochrane Library（ Issue 5,2014）. Published or unpublished materials in Chinese and English were manually searched in the library of Anhui Medical University. All the searched materials were read. The quality of the trials were assessed and extracted by 2 independent evaluators,and the information we need was analyzed by the Cochrane Collaboration Rev Man 5. 2. 2 software. Results Fifteen published clinical trials were suitable for inclusion in the review. The result of the Meta-analysis proved that there was difference between PKP and PVP in the rate of leakage of bone cement,postoperative anterior flange height of vertebral body,postoperative cobb angle and the change value of the cobb angle before and after surgery（ P〈0. 05）,and there was no difference in the long- term recurrence rate of fracture（ P〉0. 05）. Conclusions Compared with PVP,PKP can reduce the rate of leakage of bone cement,improve the kyphosis,and restore vertebral body height. But it can not reduce the long-term recurrence rate of fracture. The trials of this review are limited,and most of them are not randomized controlled ones,so there will be some bias,and in order to improve the conclusion,we need further research on data of multicenter,large scale randomized controlled trials.