经皮椎体后凸成形和椎弓根螺钉内固定治疗老年骨质疏松胸腰椎压缩性骨折的Meta分析

Percutaneous kyphoplasty and pedicle screw fixation in the treatment of senile osteoporotic thoracolumbar compression fracture: a meta-analysis

背景:治疗老年骨质疏松性胸腰椎压缩性骨折最常见的两种手术方式为经皮椎体后凸成形和椎弓根螺钉内固定,而选择何种手术方式仍存在争议,需要更多的循证医学证据来评价两种术式的优缺点。目的:运用Meta分析的方法评价两种手术方式治疗老年骨质疏松椎体压缩性骨折的临床疗效。方法:使用计算机检索在2017年5月之前在CNKI、万方、维普中文数据库、CBM、EMBASE、PubMed、Cochrane图书馆中所有公开发表的,国内外有关经皮椎体后凸成形与椎弓根螺钉内固定手术用于治疗老年性骨质疏松性椎体压缩性骨折的随机及非随机对照研究的文章,并且以手工检索的方式去查究相关会议论文,追溯近年来所纳入的相关参考文献。最终由2位评价员按照Cochrane协作网制定的标准进行逐个质量的评价后,对最终符合所选的纳入标准的研究数据用Rev Man5.3软件进行统计分析。结果与结论:共纳入7篇文献,包括596例患者。Meta分析结果显示:与椎弓根螺钉内固定术相比较,经皮椎体后凸成形手术时间短[MD=-100.09,95%CI(-161.63,-38.56),P=0.001],术中出血量少[MD=-309.86,95%CI(-500.16,-119.57),P=0.001],据术后目测类比评分疼痛缓解更明显[MD=-2.55,95%CI(-4.19,-0.91),P=0.002],术后椎体压缩率的恢复更理想[MD=-9.39,95%CI(-11.93,-6.86),P<0.000 01],在术后ODI评分的比较上无明显统计学意义[MD=-2.76,95%CI(-7.78,2.26),P=0.28],两组病例手术后Cobb角均下降,但之间差异无统计学意义[MD=-1.42,95%CI(-4.09,1.25),P=0.30]。提示:经皮椎体后凸成形与椎弓根螺钉内固定在术后cobb角及ODI评分这两个观察指标的比较上无显著差别。经皮椎体后凸成形在手术时间、术中出血量、术后缓解疼痛、术后椎体压缩率的改善方面则显得更有优势,但此结论仍需用大样本的、多中心随机对照的相关研究去进一步证实。

BACKGROUND： Percutaneous kyphoplasty and pedicle screw fixation are commonly used methods for treatment of senile osteoporotic vertebral compression fractures. The choice of surgical approach is still controversial. More evidence-based medicine is needed to evaluate the advantages and disadvantages of both procedures. OBJECTIVE： To evaluate the clinical effects of percutaneous kyphoplasty and pedicle screw fixation in the treatment of senile osteoporotic vertebral compression fractures using meta-analysis. METHODS： We performed a systematic search of CNKI, Wanfang Data, VIP, CBM, EMBASE, PubMed, Chinese database Cochrane Library by computer as well as some relevant conference papers by hand to collect the randomized and non-randomized controlled studies concerning percutaneous kyphoplasty and pedicle screw fixation for treating senile osteoporotic vertebral compression fractures before May 2017. The quality was assessed by two evaluation members according to the Cochrane collaboration network standard one by one. The studies meeting the inclusion criteria were analyzed using Rev Man5.3 software. RESULTS AND CONCLUSION： A total of 7 articles were included in the study, including 596 patients. Meta-analysis results showed that： compared with pedicle screw fixation, operation time was shorter [MD=-100.09, 95%CI（-161.63,-38.56）, P=0.001]; intraoperative blood loss was less [MD=-309.86, 95%CI（-500.16,-119.57）, P=0.001]; Visual Analogue Scale score of postoperative pain relief was more obvious [MD=-2.55, 95%CI（-4.19,-0.91）, P=0.002]; recovery of postoperative vertebral compression rate was better [MD=-9.39, 95%CI（-11.93,-6.86）, P 〈 0.000 01] during percutaneous kyphoplasty. Postoperative Oswestry Disability Index score was not statistically significant [MD=-2.76, 95%CI（-7.78, 2.26）, P=0.28] between the two groups. Postoperative Cobb angle decreased in both groups, but no significant difference was found between them [MD=-1.42, 95%CI（-4.09, 1.25）, P=0.30]. These findings verify that no significant difference in postoperative Cobb angle or Oswestry Disability Index score was found between percutaneous kyphoplasty and pedicle screw fixation. Percutaneous kyphoplasty has advantages in operation time, intraoperative blood loss, postoperative pain relief, and recovery of postoperative vertebral compression rate. However, our conclusion still needs to be confirmed by large-sample multi-center randomized controlled studies.