明胶海绵预防经皮椎体成形术骨水泥渗漏的Meta分析

Meta-analysis of gelfoam in preventing bone cement leakage during percutaneous vertebroplasty

目的系统评价明胶海绵在经皮椎体成形术(PVP)中预防骨水泥渗漏的有效性。方法检索Pubmed、Cochrane Library、Embase、Web of ScienceTM、中国生物医学文献数据库、中国期刊全文数据库、万方数据库、维普数据库,搜集所有PVP中预注射明胶海绵的随机对照试验和队列研究。由两名研究者分别进行文献筛选、纳入研究质量评价并提取数据。采用R软件进行Meta分析。结果纳入5项前瞻性队列研究和4项回顾性队列研究,共计717例(830椎)患者,其中明胶海绵组358例(419椎),对照组359例(411椎)。Meta分析显示明胶海绵组骨水泥渗漏发生率低于对照组(P<0.05);术后VAS评分与对照组比较,差异无统计学意义(P>0.05)。各项研究均未明确提及明胶海绵预注射的不良反应。结论PVP术中应用明胶海绵预注射可有效降低骨水泥渗漏率,而在术后疼痛改善方面,其与传统PVP差异不大。

Objective To systematically review the effectiveness of gelatin sponge in preventing bone cement leakage during percutaneous vertebroplasty(PVP).Methods By retrieving Pubmed,Cochrane Library,Embase,Web of ScienceTM,CBM,CNKI,Wanfang and VIP Databases,all randomized controlled trials(RCTs)and cohort studies of gelatin sponge pre-injection during PVP were collected.Two researchers screened the literature,evaluated the quality of included studies and extracted the data.Meta-analysis was performed by using R software.Results Five prospective cohort studies and 4 retrospective cohort studies were included with a total of 717 patients 830 vertebrae(358 patients 419 vertebrae in gelfoam group and 359 patients 411 vertebrae in control group).Meta analysis showed that the incidence of bone cement leakage in gelfoam group was lower than that in control group(P<0.05).There was no statistical difference in postoperative visual analogue scale score between the two groups(P>0.05).No adverse reactions of gelfoam preinjection were definitely involved in the above studies.Conclusion The use of gelatin sponge pre-injection for PVP can effectively reduce the leakage rate of bone cement,and it obtains similar effect of postoperative pain relief compare with the traditional procedure.