Osteoporotic vertebral compression fractures(OVCFs)are the most common fragility fracture and significantly influence the quality of life in the elderly.Currently,the literature lacks a comprehensive narrative review ...Osteoporotic vertebral compression fractures(OVCFs)are the most common fragility fracture and significantly influence the quality of life in the elderly.Currently,the literature lacks a comprehensive narrative review of the management of OVCFs.The purpose of this study is to review background information,diagnosis,and surgical and non-surgical management of the OVCFs.A comprehensive search of PubMed and Google Scholar for articles in the English language between 1980 and 2021 was performed.Combinations of the following terms were used:compression fractures,vertebral compression fractures,osteoporosis,osteoporotic compression fractures,vertebroplasty,kyphoplasty,bisphosphonates,calcitonin,and osteoporosis treatments.Additional articles were also included by examining the reference list of articles found in the search.OVCFs,especially those that occur over long periods,can be asymptomatic.Symptoms of acute OVCFs include pain localized to the mid-line spine,a loss in height,and decreased mobility.The primary treatment regimens are pain control,medication management,vertebral augmentation,and anterior or posterior decompression and reconstructions.Pain control can be achieved with acetaminophen or nonsteroidal anti-inflammatory drugs for mild pain or opioids and/or calcitonin for moderate to severe pain.Bisphosphonates and denosumab are the first-line treatments for osteoporosis.Vertebroplasty and kyphoplasty are reserved for patients who have not found symptomatic relief through conservative methods and are effective in achieving pain relief.Vertebroplasty is less technical and cheaper than kyphoplasty but could have more complications.Calcium and vitamin D supplementation can have a protective and therapeutic effect.Management of OVCFs must be combined with multiple approaches.Appropriate exercises and activity modification are important in fracture prevention.Medication with different mechanisms of action is a critical long-term causal treatment strategy.The minimally invasive surgical interventions such as vertebroplasty and kyphoplasty are reserved for patients not responsive to conservative therapy and are recognized as efficient stopgap treatment methods.Posterior decompression and fixation or Anterior decompression and reconstruction may be required if neurological deficits are present.The detailed pathogenesis and related targeted treatment options still need to be developed for better clinical outcomes.展开更多
文摘Osteoporotic vertebral compression fractures(OVCFs)are the most common fragility fracture and significantly influence the quality of life in the elderly.Currently,the literature lacks a comprehensive narrative review of the management of OVCFs.The purpose of this study is to review background information,diagnosis,and surgical and non-surgical management of the OVCFs.A comprehensive search of PubMed and Google Scholar for articles in the English language between 1980 and 2021 was performed.Combinations of the following terms were used:compression fractures,vertebral compression fractures,osteoporosis,osteoporotic compression fractures,vertebroplasty,kyphoplasty,bisphosphonates,calcitonin,and osteoporosis treatments.Additional articles were also included by examining the reference list of articles found in the search.OVCFs,especially those that occur over long periods,can be asymptomatic.Symptoms of acute OVCFs include pain localized to the mid-line spine,a loss in height,and decreased mobility.The primary treatment regimens are pain control,medication management,vertebral augmentation,and anterior or posterior decompression and reconstructions.Pain control can be achieved with acetaminophen or nonsteroidal anti-inflammatory drugs for mild pain or opioids and/or calcitonin for moderate to severe pain.Bisphosphonates and denosumab are the first-line treatments for osteoporosis.Vertebroplasty and kyphoplasty are reserved for patients who have not found symptomatic relief through conservative methods and are effective in achieving pain relief.Vertebroplasty is less technical and cheaper than kyphoplasty but could have more complications.Calcium and vitamin D supplementation can have a protective and therapeutic effect.Management of OVCFs must be combined with multiple approaches.Appropriate exercises and activity modification are important in fracture prevention.Medication with different mechanisms of action is a critical long-term causal treatment strategy.The minimally invasive surgical interventions such as vertebroplasty and kyphoplasty are reserved for patients not responsive to conservative therapy and are recognized as efficient stopgap treatment methods.Posterior decompression and fixation or Anterior decompression and reconstruction may be required if neurological deficits are present.The detailed pathogenesis and related targeted treatment options still need to be developed for better clinical outcomes.
文摘目的:系统评价椎体支架成形术(vertebral body stenting,VBS)和经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)的有效性和安全性。方法:应用计算机检索中国知网、万方数据库、维普网、中国生物医学文献服务系统、PubMed、Web of Science、Embase和Cochrane Library中VBS和PKP治疗OVCF的对比研究文献,检索时限均为建库起至2023年12月20日。试验组采用VBS治疗,对照组采用PKP治疗,且均采用双侧椎弓根入路。2名研究人员分别独立进行文献筛选、数据提取和纳入研究的质量评价。采用Stata18.0软件进行Meta分析。结果:共检索到196篇文献,最终纳入10篇文献,共涉及707例患者,其中试验组353例、对照组354例。Meta分析结果显示,试验组的手术时间长于对照组[WMD=9.02,95%CI(2.72,15.32),P=0.005],骨水泥填充量多于对照组[WMD=1.00,95%CI(0.34,1.65),P=0.003],术后伤椎后凸Cobb角、局部后凸Cobb角均小于对照组[WMD=-3.16,95%CI(-5.22,-1.10),P=0.003;WMD=-1.87,95%CI(-2.11,-1.64),P=0.000],术后Beck指数大于对照组[WMD=0.16,95%CI(0.11,0.20),P=0.000],2组术中出血量、住院时间、骨水泥渗漏发生率、其他不良事件发生率的差异均无统计学意义[WMD=0.19,95%CI(-0.18,0.55),P=0.317;WMD=0.09,95%CI(-0.12,0.29),P=0.410;RR=0.96,95%CI(0.69,1.32),P=0.799;RR=0.39,95%CI(0.06,2.34),P=0.301]。结论:现有证据表明,VBS手术时间长于PKP,骨水泥填充量多于PKP,在恢复和维持伤椎正常形态方面优于PKP,二者在术中出血量、住院时间及安全性方面相当。
