网袋椎体成形与常规椎体成形治疗骨质疏松性椎体压缩骨折有效与安全性的Meta分析

Meta-analysis of efficacy and safety of bone filling bag vertebroplasty and percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fracture

目的:目前对于网袋椎体成形与常规椎体成形治疗骨质疏松性椎体压缩骨折的有效性与安全性是否存在差异尚有争论。文章系统评价网袋椎体成形与常规椎体成形治疗骨质疏松性椎体压缩骨折的有效性与安全性。方法:计算机检索在2020年3月以前的中国知网、万方、维普、EMBASE、PubMed、CBM、The Cochrane library等数据库,搜集有关网袋椎体成形(Vesselplasty)与常规椎体成形(PVP)治疗骨质疏松性椎体压缩骨折的随机对照试验和队列研究,并且以手工检索相关论文。由2位评价员独立筛选文献、提取资料并评价纳入研究的方法学质量后,采用Stata/SE 12.0软件进行Meta分析。结果:(1)共纳入7个研究,共包含709例患者,其中网袋组321例,常规组388例,有2个随机对照试验的文献质量为B级,2个队列研究的NOS量表评分为8分,另外3个队列研究的NOS量表评分为7分;(2)Meta分析结果显示:两种术式在降低术后Cobb角(MD=-1.92,95%CI:-2.15至-1.68,P<0.05)和骨水泥渗漏率(RR=0.15,95%CI:0.07-0.30,P<0.05)方面的差异均有显著性意义;两种术式在降低术后目测类比评分(MD=-0.03,95%CI:-0.12-0.06,P=0.521)和术后Oswestry功能障碍指数(MD=0.16,95%CI:-0.93-1.26,P=0.770)方面差异无显著性意义。结论:与常规椎体成形相比,网袋椎体成形在改善伤椎术后Cobb角和减少骨水泥渗漏率方面具有显著优势,两者在术后目测类比评分和术后Oswestry功能障碍指数方面的临床疗效相似。鉴于纳入文献的质量有限,上述结论尚需更多高质量的多中心随机对照试验来提供证据支持。

OBJECTIVE:It remains disputed whether there is a difference in efficacy and safety between bone filling bag vertebroplasty and percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fracture.This study systematically analyzed the efficacy and safety of bone filling bag vertebroplasty and percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fracture.METHODS:A computer-based online search of CNKI,Wanfang,VIP,EMBASE,PubMed,CBM,and The Cochrane library was performed to retrieve randomized controlled trial studies and cohort studies regarding bone filling bag vertebroplasty and percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fracture published before March 2020.Moreover,related papers were retrieved manually.After two evaluators independently selected literature,extracted data and evaluated the quality of methodology included in the study,meta-analysis was carried out by using Stata/SE 12.0 software.RESULTS:(1)A total of seven articles were included,with 709 patients,of whom 321 were treated with bone filling bag vertebroplasty and 388 with percutaneous vertebroplasty.The quality of the two randomized controlled trials was grade B.The scores of NOS in two cohort studies were 8.The other three cohorts scored 7 on the NOS scale.(2)The meta-analysis results showed that there were significant differences between the two methods in reducing Cobb angle(MD=-1.92,95%CI:-2.15 to-1.68,P<0.05)and the leakage rate of bone cement(RR=0.15,95%CI:0.07-0.30,P<0.05).There was no significant difference between the two methods in reducing visual analogue scale score(MD=-0.03,95%CI:-0.12-0.06,P=0.521)and Oswestry disability index(MD=0.16,95%CI:-0.93-1.26,P=0.770).CONCLUSION:Compared with the conventional percutaneous vertebroplasty,bone filling bag vertebroplasty has a significant advantage in improving Cobb angle and reducing the leakage rate of bone cement.The clinical therapeutic effects of the two methods are similar in visual analogue scale score and Oswestry disability index.In view of the limited quality of the included literature,more high-quality multicenter randomized controlled trials are needed to provide evidence support for the above conclusion.