Jack椎体扩张器后凸成形治疗骨质疏松性椎体压缩骨折:有效及安全的Meta分析

Meta-analysis of efficacy and safety of Jack kyphoplasty for osteoporotic vertebral compression fractures

目的:Jack椎体扩张器与球囊椎体后凸成形治疗骨质疏松性椎体压缩骨折均有满意的临床疗效,但两种术式孰优孰劣仍存在较大争议。为此,文章系统评价Jack椎体扩张器与球囊椎体后凸成形治疗骨质疏松性椎体压缩性骨折的有效性与安全性。方法:计算机检索在2020年7月前万方、维普、中国知网、PubMed、EMBASE、The Cochrane library和CBM数据库发表的文献,搜集有关Jack椎体扩张器与球囊椎体后凸成形治疗骨质疏松性椎体压缩性骨折的临床对照研究。由2位评价员独立筛选文献、提取资料并评价(根据Cochrane手册及NOS量表)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篇文献,有3篇随机对照试验的文献质量等级评为B级,4篇队列研究NOS量表评分均大于5分,共包含473例患者,其中Jack椎体扩张器后凸成形组229例,球囊椎体后凸成形组244例;(2)Meta分析结果显示:在改善Cobb角方面,Jack椎体扩张器后凸成形优于球囊椎体后凸成形术(MD=-2.2,95%CI:-4.07至-0.36,P=0.001);在椎体前缘高度方面,Jack椎体扩张器后凸成形高于球囊椎体后凸成形术(MD=2.02,95%CI:1.08-2.96,P=0.000);在骨水泥渗漏率方面,Jack椎体扩张器后凸成形低于球囊椎体后凸成形术(RR=0.32,95%CI:0.15-0.68,P=0.003);两组患者在术后目测类比评分(MD=-0.07,95%CI:-0.26-0.13,P>0.05)、骨水泥注入量(MD=-0.08,95%CI:-0.21-0.06,P>0.05)、手术时间(MD=-0.51,95%CI:-4.85-3.83,P>0.05)及术中出血量(MD=0.44,95%CI:-0.47-1.35,P>0.05)方面的比较差异均无显著性意义。结论:与球囊椎体后凸成形相比,Jack椎体扩张器后凸成形在改善Cobb角、改善椎体前缘高度以及降低骨水泥渗漏率方面显得更有优势,但此结论仍需用大样本的、多中心随机对照试验去进一步证实。

OBJECTIVE:Both Jack kyphoplasty and balloon kyphoplasty have satisfactory results in the treatment of osteoporotic vertebral compression fractures.However,whether the two methods are better or not is still controversial.Thus,this study systemically evaluated the efficacy and safety of Jack vertebral dilatorkyphoplasty and balloon-kyphoplasty in the treatment of osteoporotic vertebral compression fracture.METHODS:Wanfang,VIP,CNKI,PubMed,EMBASE,the Cochrane Library,CBM and other databases were searched by computer before July 2020.The clinical controlled studies on Jack kyphoplasty and balloon kyphoplasty in the treatment of osteoporotic vertebral compression fracture were collected.After two evaluators independently selected literature,extracted data and evaluated the quality of methodology included in the study(according to Cochrane Handbook and NOS scale),meta-analysis was carried out by using Stata/SE 12.0 software.RESULTS:(1)Seven articles were included;the quality of the three randomized controlled trial articles was grade B,and the NOS scores of four cohort studies were greater than 5.A total of 473 patients were included in the final analysis,including 229 cases in Jack kyphoplasty group and 244 cases in balloon kyphoplasty group.(2)The results of meta-analysis showed that Jack kyphoplasty was better than balloon kyphoplasty in terms of Cobb angle(MD=-2.2,95%CI:-4.07 to-0.36,P=0.001).Jack kyphoplasty was higher than balloon kyphoplasty in terms of anterior vertebral height(MD=2.02,95%CI:1.08-2.96,P=0.000).Jack kyphoplasty was lower than balloon kyphoplasty in terms of cement leakage rate(RR=0.32,95%CI:0.15-0.68,P=0.003).There were no significant differences in postoperative visual analogue scale score(MD=-0.07,95%CI:-0.26-0.13,P>0.05),bone cement injection(MD=-0.08,95%CI:-0.21-0.06,P>0.05],operation time(MD=-0.51,95%CI:-4.85-3.83,P>0.05],and intraoperative blood loss(MD=0.44,95%CI:-0.47-1.35,P>0.05)between the two groups.CONCLUSION:Compared with balloon kyphoplasty,Jack kyphoplasty has more advantages in reducing Cobb angle,improving anterior height of vertebral body and reducing cement leakage rate.However,this conclusion still needs to be further confirmed by large-sample and multi-center randomized controlled trials.