经皮椎体支架系统治疗骨质疏松性椎体压缩性骨折疗效的Meta分析

Efficacy of percutaneous vertebral stent system in the treatment of osteoporotic vertebral compression fractures:a Meta-analysis

目的:探讨经皮椎体支架系统治疗骨质疏松性椎体压缩性骨折的疗效。方法:计算机检索PubMed、Cochrane Library、Embase、中国知网、万方、维普数据库中所有涉及经皮椎体支架系统和经皮椎体后凸成形术治疗骨质疏松性椎体压缩性骨折的文献。检索时间限定为建库以来至2023年12月31日。结局指标包括伤椎Cobb角、伤椎Beck指数、疼痛视觉模拟评分、Oswestry功能障碍指数、骨水泥渗漏率、手术时间、术中出血量、骨水泥注入量。利用RevMan 5.4软件进行Meta分析。结果:9项研究纳入分析,涵盖研究对象562例。Meta分析结果显示:经皮椎体支架系统治疗骨质疏松性椎体压缩性骨折在伤椎Cobb角(MD=-2.47度,95%CI-3.75~-1.19度,P=0.000 2)、伤椎Beck指数(MD=0.18,95%CI 0.01~0.36,P=0.04)以及骨水泥渗漏率(MD=0.48,95%CI 0.28~0.81,P=0.006)方面优于经皮椎体后凸成形术,但前者手术时间更长(MD=5.91 min, 95%CI 0.24~11.58 min,P=0.04)、术中骨水泥用量更多(MD=1.45 mL,95%CI 0.30~2.60 mL,P=0.01),而两者在疼痛视觉模拟评分(MD=-0.18分,95%CI-0.40~0.04分,P=0.12)、Oswestry功能障碍指数(MD=-0.58,95%CI-1.74~0.57,P=0.32)以及术中出血量(MD=0.06 mL,95%CI-0.27~0.38 mL,P=0.73)的比较,差异无统计学意义。结论:经皮椎体支架系统治疗骨质疏松性椎体压缩性骨折可获得与经皮椎体后凸成形术相当的临床疗效,而且在矫正椎体后凸畸形以及减少骨水泥渗漏方面更具优势。

Objective:To investigate the effect of percutaneous vertebral body stent system in the treatment of osteoporotic vertebral compression fractures.Methods:We searched PubMed,the Cochrane Library,Embase,China National Knowledge Infrastructure,Wanfang database and VIP database for all the articles about the treatment of osteoporotic vertebral compression fracture using vertebral body stent system or percutaneous kyphoplasty from the establishment of databases to December 31st,2023.The outcome measures included Cobb Angle of fractured vertebrae,Beck Index of fractured vertebrae,Visual Analogue Scale(VAS),Oswestry Dysfunction Index(ODI),bone cement leakage rate,operative time,intraoperative blood loss and bone cement injection.RevMan 5.4 software was used for Meta-analysis.Results:9 studies including 662 subjects were included in the analysis.The results of Meta-analysis showed that the treatment of osteoporotic vertebral compression fractures with percutaneous vertebral body stent system was superior to percutaneous kyphoplasty in terms of Cobb Angle(MD=-2.47 degree,95%CI-3.75--1.19 degree,P=0.0002),Beck Index(MD=0.18,95%CI 0.01-0.36,P=0.04)and bone cement leakage rate(MD=0.48,95%CI 0.28-0.81,P=0.006),but the former had longer operation time(MD=5.91 min,95%CI 0.24-11.58 min,P=0.04)and more bone cement(MD=1.45 mL,95%CI 0.30-2.60 mL,P=0.01).There were no significant differences in VAS score of pain(MD=-0.18,95%CI-0.40-0.04,P=0.12),ODI(MD=-0.58,95%CI-1.74-0.57,P=0.32)and intraoperative blood loss(MD=0.06 mL,95%CI-0.27-0.38 mL,P=0.73)between the two groups.Conclusion:The clinical efficacy of percutaneous vertebral body stent system in the treatment of osteoporotic vertebral compression fractures is comparable to that of percutaneous kyphoplasty,and it has more advantages in the correction of kyphotic deformity and the reduction of bone cement leakage.