经皮椎体后凸成形后再发骨折相关因素的Meta分析

Risk factors for fractures secondary to percutaneous kyphoplasty: a meta-analysis

背景:经皮椎体后凸成形术是在椎体成形术基础上改良而来,能更好的恢复压缩椎体高度,减少骨水泥渗漏,近年来普遍应用于临床上骨质疏松性椎体压缩性骨折的治疗,但时常有报道术后发生强化椎体及邻近节段椎体的再发骨折,对于影响再发骨折的相关因素仍存在争议。目的:通过Meta分析探讨老年骨质疏松性椎体压缩骨折患者经皮椎体后凸成形后再发骨折的相关因素。方法:计算机搜索The Cochrane Library、PubMed、中国生物文献数据库、CNKI、万方数据库,并手工辅助检索主要的中英文骨科杂志,并追查纳入文献的参考文献,收集2009年1月至2019年4月有关老年骨质疏松性椎体压缩骨折患者经皮椎体后凸成形后再发骨折因素分析的文献,提取相关数据后用RevMan 5.3软件进行统计分析。结果与结论:①年龄[WMD=1.87,95%CI(0.79,2.95),P <0.05]、骨密度[WMD=-0.46,95%CI(-0.61,-0.31),P<0.05]、骨水泥渗漏[OR=2.68,95%CI(2.11,3.39),P<0.00001]、初次术后后凸角矫正量[WMD=2,95%CI(0.34,3.66),P=0.02]、初次术后椎体高度恢复率[WMD=5.25,95%CI(2.16,8.34),P=0.000 9]等因素与经皮椎体后凸成形后再发骨折相关;②而经皮椎体后凸成形后再发骨折与性别[OR=0.83,95%CI(0.67,1.02),P>0.05]、体质量指数[WMD=-0.27,95%CI(-1.06,0.51),P=0.49]、骨水泥注入量[WMD=0.06,95%CI(-0.21,0.32),P=0.68]、手术入路方式[OR=0.87,95%CI(0.61,1.25),P=0.46]、原发骨折为胸腰段(T11-L2)[OR=1.48,95%CI(0.93,2.38),P=0.1]无关;③结果表明,年龄、骨密度、骨水泥渗漏、初次术后后凸角矫正及初次术后椎体高度恢复率均与椎体后凸成形后再发骨折相关,而性别、体质量指数、骨水泥注入量、原发骨折为胸腰段、手术入路方式与椎体后凸成形后再发骨折无明显相关性,以上结论还需以后纳入更多的高质量文献加以研究验证。

BACKGROUND: Percutaneous kyphosis is improved on the basis of vertebroplasty, which can well restore the height of compressed vertebral body and reduce bone cement leakage. In recent years, it has been widely used in the treatment of osteoporotic vert ebral compression fracture. However, it is often reported that there are recurrent fractures of the enhanced vertebral bod y and adjacent vertebral body after surgery, and the related factors affecting the recurrent fracture are still controversial. OBJECTIVE: To identify the risk factors for the fractures secondary to percutaneous kyphoplasty for treating osteoporotic vertebral compression fractures in the elderly by meta-analysis. METHODS: A comprehensive search was conducted for the studies published from January 2009 to April 2019 on the risk factors for secondary fractures after percutaneous kyphoplasty in the Cochrane Library, PubMed, CBM, CNKI and WanFang databases and manually as well. After the relevant data were extracted, statistical analysis was carried out with RevMan 5.3 software. RESULTS AND CONCLUSION:(1) The secondary fracture after percutaneous kyphoplasty for osteoporotic vertebral compression fracture was related to age [WMD=1.87, 95%CI(0.79, 2.95), P < 0.05], bone mineral density [WMD=-0.46, 95%CI(-0.61,-0.31), P < 0.05], bone cement leakage [OR=2.68, 95% CI(2.11, 3.39), P < 0.000 01], correction of kyphosis angle after primary operation [WMD=2, 95% CI(0.34, 3.66), P=0.02] and recovery rate of vertebral height after primary operation [WMD=5.25, 95% CI(2.16, 8.34), P=0.000 9].(2) The secondary fracture after percutaneous kyphoplasty for osteoporotic vertebral compression fracture was not related to sex [OR=0.83, 95% CI(0.67, 1.02), P > 0.05], body mass index [WMD=-0.27, 95% CI(-1.06, 0.51), P=0.49], cement volume [WMD=0.06, 95% CI(-0.21, 0.32), P=0.68], surgical approach [OR=0.87, 95%CI(0.61,1.25), P=0.46], primary fracture was thoracolumbar segment(T11-L2) [OR=1.48, 95% CI(0.93, 2.38), P=0.1].(3) These results suggest that age, bone mineral density, bone cement leakage, correction of kyphosis angle after primary operation and recovery rate of vertebral height after primary operation may be the risk factors closely correlative to the secondary fracture after percutaneous kyphoplasty. There has not been enough evidence to support the associations between the secondary fracture and sex, body mass index, cement volume, surgical approach or thoracolumbar spine, and the above conclusions need to be studied and verified by more high quality literature in the future.