椎体后凸成形术治疗骨质疏松性椎体压缩性骨折行单侧与双侧入路疗效评价的Meta分析

Meta-analysis of the efficacy of vertebral kyphoplasty in the treatment of osteoporotic vertebral compression fractures with unilateral and bilateral approaches

目的比较椎体后凸成形术单侧与双侧入路治疗骨质疏松性椎体压缩性(OVCF)的疗效优劣。方法计算机检索Pubmed、Embase、Web of science、Cochrane Library、中国知网、万方数据库、维普数据库从建库到2018年8月的文献,检索通过单侧和双侧入路椎体后凸成形术(PKP)治疗骨质疏松性椎体压缩性骨折的中英文文献,排除重复研究、回归性分析,纳入随机对照试验,由两名评价员按照纳入和排除标准对文献质量进行评价和筛选,运用Review Manager 5.3软件进行Meta分析。结果共纳入随机对照试验文献13篇,共1 072例患者,行手术单侧入路者534例,双侧入路者538例。Meta分析结果显示,椎体后凸成形术单侧入路与双侧入路在手术时间、骨水泥注入量、术中透视次数方面比较差异均有显著统计学意义(P<0.01);两种手术入路方式在术后VAS评分、骨水泥渗漏率、术后cobb角、椎体前缘高度恢复率、术后ODI评分方面比较差异均无统计学意义(P≥0.05)。结论椎体后凸成形术单侧入路在手术时间、患者和术者术中所承受的放射量均少于双侧入路,双侧入路的骨水泥使用量也明显多于单侧,因此对于大多中老年OVCF,行单侧入路手术更有利。

Objective To compare the advantages and disadvantages of unilateral and bilateral approach in vertebral kyphoplasty for the treatment of osteoporotic vertebral compression fractures (OVCF). Methods The electronic databases of Pubmed, Embase, Web of Science, Cochrane Library, the China National Knowledge Infrastructure (CNKI), the Wanfang Database, the VIP database were searched for the Chinese and English literature in the treatment of osteoporotic vertebral compression fractures by unilateral and bilateral vertebral percutaneous kyphoplasty (PKP) from the establishment of these database to August 2018. Duplicate studies and regression analyses were excluded, and randomized controlled trials were included. The quality of the literature was evaluated and screened by two reviewers according to inclusion and exclusion criteria. The meta-analysis was conducted using Review Manager 5.3 software. Results A total of 13 randomized controlled trials were included, with a total of 1 072 patients, including 534 patients who underwent unilateral approach and 538 patients who underwent bilateral approach. Meta-analysis results showed that the unilateral approach and bilateral approach in kyphoplasty had statistically significant differences in terms of operative time, the volume of bone cement injection, and the number of intraoperative fluoroscopy (P<0.01). There were no significant differences in the postoperative VAS score, bone cement leakage rate, postoperative cobb angle, vertebral body height recovery rate, and postoperative ODI score (P≥0.05). Conclusion The operation time, the radiation volume of patients and surgeons during operation in kyphoplasty using unilateral approach are less than those using bilateral approach. The volume of bone cement used in the bilateral approach is also significantly more than that in the unilateral approach. Therefore, for most middle-aged and elderly OVCF, unilateral approach is more beneficial.