经皮椎体强化术后邻近椎体骨折影响因素的Meta分析

Influencing Factors of Adjacent Vertebral Fractures after Percutaneous Vertebral Augmentation:A Meta-analysis

目的:通过系统评价的方法分析骨质疏松性椎体压缩骨折患者经皮椎体强化术后邻近椎体骨折相关影响因素。方法:检索PubMed、Web of Science、Embase、Cochrane Library、中国知网、万方数据库、维普网、中国生物医学文献数据库,筛选骨质疏松性椎体压缩骨折患者经皮椎体强化术后邻近椎体骨折影响因素的相关研究,检索时间为各数据库建库至2023年5月21日。采用RevMan 5.4和Stata 17软件进行Meta分析。结果:最终纳入43个病例对照研究,均为高质量文献,总样本量为10601例。Meta分析结果显示,经皮椎体强化术后邻近椎体骨折的危险因素包括高龄[OR=1.13,95%CI(1.08,1.17)]、低体质量指数[OR=2.29,95%CI(1.36,3.84)]、吸烟[OR=2.77,95%CI(1.52,5.05)]、低骨密度[OR=3.88,95%CI(2.64,5.70)]、患有糖尿病[OR=2.25,95%CI(1.57,3.21)]、合并脊柱侧弯[OR=4.41,95%CI(2.52,7.73)]、伤椎数较多[OR=2.02,95%CI(1.43,2.85)]、骨水泥渗漏[OR=3.47,95%CI(2.77,4.35)]、骨水泥注入量过大[OR=2.94,95%CI(2.50,3.46)]、椎体高度恢复率偏大[OR=1.28,95%CI(1.10,1.49)]、局部Cobb角过度矫正[OR=1.27,95%CI(1.04,1.55)];保护因素为抗骨质疏松治疗[OR=0.32,95%CI(0.21,0.49)]。结论:高龄、低体质量指数、吸烟、低骨密度、患有慢性阻塞性肺疾病、患有糖尿病、合并脊柱侧弯、伤椎数较多、骨水泥渗漏、骨水泥注入量过大、椎体高度恢复率偏大、局部Cobb角过度矫正是经皮椎体强化术后邻近椎体骨折的危险因素,在临床实践中应积极控制可控的危险因素,并制定合理的抗骨质疏松治疗方案以减少不良预后。以上所得出的结论,尚需更多大样本、高质量的研究进一步验证。

Objective:To analyze the related factors of adjacent vertebral fractures after percutaneous vertebral augmentation(PVA)in patients with osteoporosis vertebral compression fracture(OVCF)by a systematic review.Methods:Databases including PubMed,Web of Science,Embase,Cochrane Library,CNKI,Wanfang Data Knowledge Service platform,Vip.com,and Chinese biomedical literature database,were searched to screen relevant studies on influencing factors of adjacent vertebral fractures after PVA in patients with OVCF.The search period extended from the establishment of each database to May 21,2023.Meta-analysis was performed using RevMan 5.4 and Stata 17.Results:Finally,43 case-control studies were included,all of which were high quality literatures,with a total sample size of 10601 cases.Meta-analysis results showed that risk factors for adjacent vertebral fractures after PVA included advanced age[OR=1.13,95%CI(1.08,1.17)],low body mass index[OR=2.29,95%CI(1.36,3.84)],smoking[OR=2.77,95%CI(1.52,5.05)],low bone mineral density[OR=3.88,95%CI(2.64,5.70)],diabetes[OR=2.25,95%CI(1.57,3.21)],scoliosis[OR=4.41,95%CI(2.52,7.73)],more injured vertebra[OR=2.02,95%CI(1.43,2.85)],bone cement leakage[OR=3.47,95%CI(2.77,4.35)],excessive injection of bone cement[OR=2.94,95%CI(2.50,3.46)],high recovery rate of vertebral body height[OR=1.28,95%CI(1.10,1.49)],excessive correction of local Cobb Angle[OR=1.27,95%CI(1.04,1.55)];The protective factor was anti-osteoporosis therapy[OR=0.32,95%CI(0.21,0.49)].Conclusion:Advanced age,low body mass index,smoking,low bone mineral density,chronic obstructive pulmonary disease,diabetes,scoliosis,more injured vertebra,bone cement leakage,excessive injection of bone cement,high recovery rate of vertebral height,and excessive correction of local Cobb Angle are risk factors for adjacent vertebral fractures after PVA.In clinical practice,the controllable risk factors should be actively controlled,and a reasonable anti-osteoporosis treatment program should be formulated to reduce the adverse prognosis.The conclusions drawn above still require further validation through more large-scale and high-quality studies.