经皮椎体后凸成形与后路椎弓根钉内固定椎体强化治疗Kummell病有效与安全性的Meta分析

Efficacy and safety of percutaneous kyphoplasty versus posterior short-segment fixation with vertebra augmentation for Kummell’s disease: a meta-analysis

背景:单纯经皮椎体后凸成形治疗Kummell病存在骨水泥弥散不均匀和骨水泥移位,目前有研究推荐使用后路脊柱短节段固定结合椎体骨水泥强化治疗Kummell病。目的:利用Meta分析方法评价经皮椎体后凸成形及后路脊柱短节段固定结合椎体骨水泥强化治疗Kummell病的有效性与安全性。方法:应用计算机检索PubMed、Cochrane Library、Web of Science数据库、EMBASE、中国生物医学文献数据库、中国知网、维普和万方数据库,检索经皮椎体后凸成形(PKP组)及后路脊柱短节段固定结合椎体骨水泥强化(PSF+BC组)治疗Kummell病的随机对照试验、病例对照研究与队列研究,检索年限为建库至2020-02-01,检索语种为中文和英文。由2名评价员对所有检索的文献按照纳入及排除标准筛选文献,用NOS量表评价文献质量后采用Review Manager 5.3软件进行Meta分析。结果与结论:①最终纳入4篇文献,共200例患者,其中PKP组108例,PSF+BC组92例;②Meta分析显示,PKP组手术时间、术中出血量少于PSF+BC组[MD=-82.83,95%CI(-144.43,-21.24),Z=2.64,P=0.008;MD=-204.44,95%CI(-210.97,-197.92),Z=61.43,P<0.000 01],围术期并发症发生率低于PSF+CV组[OR=0.15,95%CI(0.03,0.91),Z=2.07,P=0.04],骨水泥渗漏率高于PSF+BC组[RR=1.99,95%CI(1.03,3.88),Z=2.03,P=0.04];两组间术后末次随访的目测类比评分、Oswestry功能障碍指数、局部后凸角比较差异均无显著性意义(P>0.05);③结果表明,经皮椎体后凸成形与后路脊柱短节段固定结合椎体骨水泥强化治疗Kummell病有效且安全,经皮椎体后凸成形可减少手术时间、术中出血量及围术期并发症,两组术式各有其优缺点,需临床医师根据患者个体情况选择。

BACKGROUND: Because the single percutaneous kyphoplasty for treating Kummell’s disease brought the uneven distribution and displacement of bone cement. Current research has recommended a posterior short-segmental fixation combined with vertebra cement augmentation for Kummell’s disease. OBJECTIVE: To evaluate the effectiveness and safety of percutaneous kyphoplasty or posterior short-segmental fixation combined with vertebral body bone cement augmentation for Kummell’s disease using meta-analysis. METHODS: PubMed, the Cochrane Library, Web of Science database, EMBASE, Chinese biomedical literature database, China National Knowledge Infrastructure, VIP and Wanfang database were retrieved for randomized controlled trials, case-control studies and cohort studies regarding percutaneous kyphoplasty and posterior short-segmental fixation combined with vertebra bone cement augmentation(posterior spinal fixation + bone cement) for Kummell’s disease. The retrieval period was from the database establishment to February 1, 2020, and the retrieval languages were Chinese and English. All the retrieved literature was screened according to inclusion and exclusion criteria by two reviewers. NOS scale was used to evaluate the literature quality, and then Review Manager 5.3 software was used for meta-analysis. RESULTS AND CONCLUSION:(1) Four articles were finally included, with 200 patients, including 108 in the percutaneous kyphoplasty group and 92 in the posterior spinal fixation + bone cement group.(2) Meta-analysis showed that operation time was significantly shorter and intraoperative blood loss was less in the percutaneous kyphoplasty group than in the posterior spinal fixation + bone cement group [MD=-82.83, 95%CI(-144.43,-21.24), Z=2.64, P=0.008;MD=-204.44, 95%CI(-210.97,-197.92), Z=61.43, P<0.000 01]. Incidence of perioperative complications was lower in the percutaneous kyphoplasty group than in the posterior spinal fixation + bone cement group [OR=0.15, 95%CI(0.03, 0.91), Z=2.07, P=0.04]. Incidence of bone cement leakage was higher in the percutaneous kyphoplasty group than in the posterior spinal fixation + bone cement group [RR=1.99, 95%CI(1.03, 3.88), Z=2.03, P=0.04]. There were no significant differences in visual analogue scale score, Oswestry disability index and kyphosis angle between the two groups in the last follow-up(P>0.05).(3) The results suggest that percutaneous kyphoplasty and posterior spinal fixation + bone cement are effective and safe in the treatment of Kummell’s disease. Percutaneous kyphoplasty can reduce the operation time, intraoperative blood loss and perioperative complications. The two methods have their own advantages and disadvantages, which should be selected by clinicians according to the individual situation of patients.