中国人群PKP、PVP术后骨水泥渗漏相关危险因素的Meta分析

A Meta-analysis of Risk Factors Related to Bone Cement Leakage after PKP and PVP in Chinese Population

目的通过Meta分析明确中国人群经皮椎体后凸成形术(PKP)、经皮椎体成形术(PVP)术后骨水泥渗漏的危险因素。方法计算机检索Embase、PubMed、Cochrane Library、维普、中国生物医学文献数据库、万方和中国知网数据库中关于中国人群PKP、PVP术后骨水泥渗漏相关危险因素的临床研究,检索时间为建库至2021年10月31日。由两名研究人员独立筛选文献并提取数据,采用纽卡斯尔-渥太华量表评价文献质量。提取相关数据后,采用Stata 14.2软件进行Meta分析。结果最终纳入20篇文献,均为病例对照研究。共纳入研究对象4700例,病例组1500例,对照组3200例。Meta分析结果显示,术前损伤椎体高度降低、骨折压缩程度>25%、术前伤椎Cobb角增大、骨水泥量增加、椎体周壁破裂、骨水泥黏度低、椎体内裂隙征与椎基静脉孔相通、椎体裂隙征、低年资医师操作是PKP、PVP术后骨水泥渗漏的危险因素(OR=-1.11,95%CI-1.28~-0.94,P<0.001;OR=2.10,95%CI 1.25~3.52,P=0.005;OR=0.85,95%CI 0.10~1.60,P=0.027;OR=0.92,95%CI 0.60~1.25,P<0.001;OR=4.25,95%CI 2.74~6.57,P<0.001;OR=2.18,95%CI 1.16~4.12,P=0.016;OR=4.02,95%CI 2.11~7.66,P<0.001;OR=2.41,95%CI 1.27~4.56,P=0.007;OR=2.65,95%CI 1.70~4.15,P<0.001)。性别、年龄、骨密度、一次性治疗椎体数、穿刺方式、骨折新鲜度、骨折部位对术后骨水泥渗漏无影响(P>0.05)。结论中国人群PKP、PVP术后骨水泥渗漏存在多种危险因素,应在术前对患者病情进行准确评估,术中仔细操作,根据患者具体情况制订个性化治疗方案,以避免PKP、PVP术后骨水泥渗漏的发生。

Objective To explore the risk factors of bone cement leakage after percutaneous kyphoplasty(PKP),percutaneous vertebroplasty(PVP)in Chinese population by meta-analysis.Methods The databases of Embase,PubMed,Cochrane Library,VIP,CBM,Wanfang and CNKI were searched for clinical research literature by computer for the risk factors of bone cement leakage after PKP and PVP in the Chinese population.The search time was set from the establishment of the database to Oct.31st,2021.Two researchers independently screened and extracted data,and Newcastle-Ottawa scale was used to evaluate the quality of the literature.After extracting relevant data,the meta-analysis was performed using Stata 14.2 software.Results Twenty articles were included,all of which were case-control studies.A total of 4700 subjects were included,including 1500 in the case group and 3200 in the control group.Risk factors for postoperative cement leakage after PKP,PVP were considered by meta-analysis to include preoperative vertebral height decreased,compression degree of fracture>25%,preoperative vertebral Cobb angle increased,bone cement increased,perivertebral wall rupture,low bone cement viscosity,intravertebral fissure sign communicated with vertebral base foramen,vertebral fissure sign,and junior physician operation(OR=-1.11,95%CI-1.28--0.94,P<0.001;OR=2.10,95%CI 1.25-3.52,P=0.005;OR=0.85,95%CI 0.10-1.60,P=0.027;OR=0.92,95%CI 0.60-1.25,P<0.001;OR=4.25,95%CI 2.74-6.57,P<0.001;OR=2.18,95%CI 1.16-4.12,P=0.016;OR=4.02,95%CI 2.11-7.66,P<0.001;OR=2.41,95%CI 1.27-4.56,P=0.007;OR=2.65,95%CI 1.70-4.15,P<0.001).Gender,age,bone density,number of vertebral bodies treated at one time,puncture method,fracture freshness,and fracture site had no influence of postoperative bone cement leakage(P>0.05).Conclusion There are multiple risk factors for bone cement leakage after PKP,PVP in the Chinese population.Therefore,accurate preoperative assessment of the patient′s condition should be carried out,and careful intraoperative operation should be performed,and individualized treatment plan should be developed according to the specific situation of the patient,to avoid the occurrence of bone cement leakage after PKP and PVP.