弯角椎体成形术对骨质疏松性椎体压缩骨折的疗效和安全性的Meta分析

Effectiveness and safety of angled percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures:a meta-analysis

目的基于Meta分析方法探讨弯角椎体成形术(PCVP)对骨质疏松性椎体压缩骨折(OVCF)的疗效和安全性。方法通过计算机检索PubMed、Cochrane Library、Web of science、中国知网、万方数据库中关于PCVP、经皮椎体成形术(PVP)治疗OVCF的随机对照试验(RCT)或回顾性队列研究(RCS)文献,检索时间为建库至2023年9月13日。根据纳入与排除标准筛选文献,进行Meta分析,结局指标包括术后视觉模拟评分法(VAS)评分、术后Oswestry功能障碍指数(ODI)评分、术后Cobb角、术后椎体高度、手术时间、术中透视次数、骨水泥注入量、骨水泥椎体分布优良率、骨水泥渗漏率、再发骨折率。结果本研究最终纳入20篇文献进行Meta分析,包括12篇RCT文献和8篇RCS文献。与PVP组比较,PCVP组术后VAS评分更低(MD=-0.15,95%CI:-0.18~-0.11,P<0.00001),术后ODI评分更低(MD=-1.63,95%CI:-3.06~-0.19,P=0.03),手术时间更短(MD=-7.15,95%CI:-10.74~-3.56,P<0.0001),术中透视次数更少(MD=-3.40,95%CI:-5.71~-1.10,P=0.004),骨水泥椎体分布优良率更高(OR=5.84,95%CI:3.58~9.51,P<0.00001),骨水泥渗漏率更低(OR=0.31,95%CI:0.23~0.42,P<0.00001),差异均有统计学意义;PCVP组术后Cobb角、术后椎体高度、骨水泥注入量和再发骨折率与PVP组比较,差异无统计学意义(P>0.05)。结论相较于PVP,PCVP对OVCF具有更好的疗效与安全性,可减轻疼痛程度,缩短手术时间,减少术中透视次数,降低骨水泥渗漏率,提升骨水泥椎体分布优良率,改善脊柱功能,若条件允许,建议选用PCVP治疗OVCF。

Objective To investigate the effectiveness and safety of angled percutaneous vertebroplasty(PCVP)in the treatment of osteoporotic vertebral compression fractures(OVCF)based on the meta-analysis method.Methods Randomized controlled trials(RCT)or retrospective cohort studies(RCS)regarding PCVP and percutaneous vertebroplasty(PVP)for the treatment of OVCF were retrieved from PubMed,Cochrane Library,Web of Science,CNKI,and Wanfang Data from inception to September 13,2023.The literature was screened according to inclusion and exclusion criteria,and a meta-analysis was performed.The outcome indicators included postoperative Visual Analogue Scale(VAS)score,postoperative Oswestry Disability Index(ODI)score,postoperative Cobb angle,postoperative vertebral height,operative time,intraoperative fluoroscopy times,bone cement injection volume,excellent and good rate of bone cement vertebral body distribution,bone cement leakage rate,and re-fracture rate.Results A total of 20 articles,including 12 RCT articles and 8 RCS articles,were included in this meta-analysis.Compared with the PVP group,the PCVP group had lower postoperative VAS scores(MD=-0.15,95%CI,-0.18 to-0.11,P<0.00001),lower postoperative ODI scores(MD=-1.63,95%CI,-3.06 to-0.19,P=0.03),shorter operative time(MD=-7.15,95%CI,-10.74 to-3.56,P<0.0001),less intraoperative fluoroscopy times(MD=-3.40,95%CI,-5.71 to-1.10,P=0.004),a higher excellent and good rate of bone cement vertebral body distribution(OR=5.84,95%CI,3.58 to 9.51,P<0.00001),and a lower bone cement leakage rate(OR=0.31,95%CI,0.23 to 0.42,P<0.00001).However,there were no significant differences in postoperative Cobb angle,postoperative vertebral height,bone cement injection volume,and re-fracture rate between the PCVP group and the PVP group(P>0.05).Conclusion Compared with PVP,PCVP has better effectiveness and safety in the treatment of OVCF,which can relieve pain,shorten operative time,reduce intraoperative fluoroscopy times and bone cement leakage rate,improve the excellent and good rate of bone cement vertebral body distribution,and enhance spinal function.If conditions permit,PCVP is recommended for the treatment of OVCF.