单侧与双侧椎弓根入路注入骨水泥治疗骨质疏松性椎体压缩骨折有效和安全性的Meta分析

Efficacy and safety of bone cement injection via unipedicular and bipedicular approaches in the treatment of osteoporotic vertebral compression fractures: a Meta-analysis

背景:采用经皮椎体成形术治疗骨质疏松性椎体压缩骨折时,对于单侧与双侧椎弓根入路注入骨水泥的有效性和安全性仍存在争议,部分研究认为单侧椎弓根入路能够缩短手术时间并减轻术后并发症;另有部分研究认为双侧椎弓根入路能使骨水泥更为均匀地分布于椎体内,可更好地缓解疼痛。目的:系统评价单侧对比双侧椎弓根入路注入骨水泥治疗骨质疏松性椎体压缩骨折的有效性及安全性。方法:电子检索PubMed、Cochranelibrary、Embase、CNKI、VIP、万方和CBM等数据库,搜索有关单侧椎体成形术对比双侧椎体成形术治疗骨质疏松性椎体压缩骨折的随机对照试验,设定文献发表时间为建库至2018-09-18。对所有符合纳入标准的临床研究进行资料提取,由2名研究员以改良后的Jadad量表独立严格地进行纳入研究的质量评价,应用Revman 5.3软件完成Meta分析。采用Egger’s检验进行发表偏倚的检验。结果与结论:共纳入14个随机对照试验,包括900例患者,其中单侧入路组452例,双侧入路组448例。Meta分析结果显示:相对于双侧入路组,单侧入路所需要的手术时间更短[WMD=-16.59,95%CI(-19.25,-13.94),P<0.001]、骨水泥注入量更少[WMD=-1.27,95%CI(-1.64,-0.89),P<0.001]、术后骨水泥渗漏率更低[RR=0.70,95%CI(0.53,0.92),P=0.01];两组术后短期与长期目测类比评分、术后短期与长期功能障碍评分及术后邻近椎体骨折发生率比较差异均无显著性意义(P> 0.05)。结果表明,2种手术方式都能有效缓解骨质疏松性椎体压缩骨折患者的疼痛症状,提高患者生活质量,但单侧椎弓根入路具有手术时间短、骨水泥注入量少、骨水泥渗漏率低的优点。

BACKGROUND:In the treatment of osteoporotic vertebral compression fractures with percutaneous vertebroplasty,the efficacy and safety of bone cement injection by unipedicular and bipedicular approaches are still controversial.Some studies suggest that bone cement injection via unipedicular approach can shorten operation time and reduce postoperative complications,while the other studies suggest that bone cement injection via bipedicular approach can make bone cement distribute more evenly in the vertebral body and relieve pain better.OBJECTIVE:To systematically assess the efficacy and safety of percutaneous vertebroplasty via unipedicular versus bipedicular approach in the treatment of osteoporotic vertebral compression fractures.METHODS:Randomized controlled trials about unipedicular versus bipedicular percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fracture published before September 18th,2018 were retrieved in the PubMed,Cochrane library,Embase,CNKI,VIP,WanFang data and CBM.Two researchers independently screened all the literatures,carried out data extraction and used improved Jadad to evaluate the methodological quality of the included studies.Meta-analysis using Revam 5.3 was conducted.Egger’s test was utilized to evaluate the publication bias.RESULTS AND CONCLUSION:Totally 14 randomized controlled trials including 900 cases were eventually included,452 cases in unipedicular approach group and 448 cases in bipedicular approach group.The Meta-analysis results showed that compared with the bipedicular approach,the unipedicular approach required shorter operation time[weighted mean difference(WMD)=-16.59,95%confidence interval(CI)(-19.25,-13.94),P<0.001],smaller amount of bone cement injected[WMD=-1.27,95%CI(-1.64,-0.89),P<0.001],and had lower incidence of cement leakage[relative risk=0.70,95%CI(0.53,0.92),P=0.01].There were no significant differences in short-and long-term Visual Analogue Scale scores,short-and long-term Oswestry Disability Index scores,and the postoperative incidence of adjacent vertebral fractures between the two groups(P>0.05).Overall,bone cement injection both via bipedicular and unipedicular approaches can lead to a significant improvement in pain relief and living quality of osteoporotic vertebral compression fracture patients,but bone cement injection via unipedicular approach can shorten operation time,reduce cement volume and lower the incidence of cement leakage compared with the bipedicular approach.