不同黏度骨水泥经皮椎体后凸成形术治疗骨质疏松性椎体压缩性骨折的有效性与安全性Meta分析

Effectiveness and safety of percutaneous kyphoplasty with different viscosity bone cement in the treatment of osteoporotic vertebral compression fracture:a meta-analysis

目的系统评价不同黏度骨水泥经皮椎体后凸成形术(PKP)治疗骨质疏松性椎体压缩骨折(OVCF)的有效性与安全性。方法计算机检索自建库至2021年4月18日收录在中国知网(CNKI)、万方(Wanfang)、维普(VIP)、PubMed、中国生物医学文献数据库(CBM)、The Cochrane library等数据库的文献,搜索有关PKP中采用高低黏度骨水泥治疗OVCF的随机对照试验(RCT)文献,并以手工检索相关论文。由2位评价员独立筛选文献、提取资料及评价纳入研究的方法学质量后,采用Review 5.3软件进行Meta分析。结果共纳入12篇RCT文献,共1089例患者,其中高黏度组544例,低黏度组545例。Meta分析结果表明:与对照组相比,研究组在降低术后视觉模拟量表(VAS)评分(MD=-0.43,95%CI:-0.67~-0.19,P<0.01)、Oswestry功能障碍指数(ODI)(MD=-3.89,95%CI:-6.32~-1.47,P<0.01)、Cobb角(MD=-1.78,95%CI:-2.08~-1.48,P<0.00001)、减少骨水泥注入量(MD=-0.18,95%CI:-0.34~-0.02,P<0.05)、缩短手术时间(MD=-6.91,95%CI:-12.84~-0.99,P<0.05)和恢复伤椎高度(MD=3.01,95%CI:1.15~4.86,P<0.01)方面均明显优于对照组;与对照组相比,研究组在降低术后骨水泥渗漏率(RR=0.40,95%CI:0.32~0.51,P<0.01)和其他并发症发生率(RR=0.55,95%CI:0.39~0.78,P<0.01)方面均明显低于对照组。结论与低黏度骨水泥相比,PKP中选用高黏度骨水泥具备更好的临床疗效及安全性。然而,上述结论仍需更多高质量、多中心的RCT进一步证实。

Objective To systematically evaluate the efficacy and safety of percutaneous kyphoplasty(PKP)with different viscosity bone cement in the treatment of osteoporotic vertebral compression fractures(OVCF).Methods Databases including CNKI,Wanfang,VIP,PubMed,CBM,and the Cochrane Library were searched for collect randomized controlled trials(RCTs)related to high and low viscosity bone cement in the treatment of OVCF during PKP,and the search time limit was from the establishment to April 18,2021.Cochrane Collaboration's tool was used to make a quality assessment.Moreover,related papers were retrieved manually.After two evaluators independently selected literature,extracted data,and evaluated the quality of methodology included in the study,Review 5.3 software was used to analyze the meta-analysis.Results A total of 12 RCT articles were included,including 1089 patients(544 cases in high viscosity group,and 545 cases in low viscosity group).The results of the meta-analysis showed that the study group was better than the control group after surgery in reducing the mean visual analogue scale(VAS)scores(MD=-0.43,95%CI:-0.67 to-0.19,P<0.01),the mean Oswestry Disability Index(ODI)(MD=-3.89,95%CI:-6.32,-1.47,P<0.01),the Cobb angle(MD=-1.78,95%CI:-2.08 to-1.48,P<0.01),reduce the cement injection volume(MD=-0.18,95%CI:-0.34 to-0.02,P<0.05),shorten the operation time(MD=-6.91,95%CI:-12.84 to-0.99,P<0.05),recovery of injured vertebral height[MD=3.01,95%CI(1.15 to 4.86),P<0.01].the study group was lower than the control group after surgery in reducing leakage rate of bone cement(RR=0.40,95%CI:0.32 to 0.51,P<0.01),incidence of other complications(RR=0.55,95%CI:0.39 to 0.78,P<0.05).Conclusion Compared with low viscosity bone cement,high viscosity bone cement in PKP has better clinical efficacy and safety.However,the above conclusions still need to be further confirmed by more high-quality,multi-center RCTs.