PVP与PKP治疗胸腰椎压缩性骨折疗效比较的Meta分析

目的运用Meta分析的方法评价椎体成形术（percutaneous vertebroplasty,PVP）与椎体后凸成形术（percutaneous kyphoplasty,PKP）治疗胸腰椎压缩性骨折的疗效。方法计算机检索1998年1月至2012年1月的中国知网、万方资源数据库、维普期刊数据库、中国生物医学文献服务系统,搜集与PVP和PKP治疗胸腰椎压缩性骨折的疗效比较的对照研究。按纳入与排除标准筛选文献,评价文献质量后采用RevMan 5.0进行数据分析。结果最终纳入10个随机对照试验,共499例患者。两组（PVP与PKP）病例术后疼痛均得到缓解,两组缓解疼痛差异无统计学意义比值比为0.06,95%CI（-0.03,0.16）,P=0.51];两组病例手术前后Cobb角均下降,但PKP组较PVP组下降更明显比值比为4.21,95%CI（3.12,5.29）,P〈0.000 01]。两组病例手术前后椎体前缘平均高度恢复率均升高,PVP组较PKP组升高更明显比值比-14.43,95%CI（-16.85,12.02）,P〈0.000 01]。两组病例手术前后椎体压缩率均降低,但PKP组降低更明显比值比为-2.13,95%CI（-3.02,-1.23）,P〈0.000 01],两组均出现术后骨水泥渗漏,但是PKP组发生率更低比值比为-4.83,95%CI（2.30,8.33）,P=0.15]。结论 PVP与PKP在缓解疼痛方面无显著差别,PKP在增加椎体高度、纠正畸形方面更有优势、更安全,但远期疗效有待观察。

Vertebroplasty Versus Kyphoplasty for Treatment of Vertebral Compression Fracture of Thoracolumbar Spine

Objective To evaluate the efficency of Vertebroplasty versus kypholasty for treatment of vertebral compression fracture of thoracolumbar spine.Methods A systematic compute-based online search(from January 1998 to January 2012) of CNKI,WANFANG,CBM and VIP database was performed to collect comparative studies on kyphoplasty and vertebroplasty in the treatment of thoracolumbar compression fracture,and meta-analysis was performed on the results.Results A total of 10 randomized,controlled domestic research were collected.Meta-analysis showed that postoperative VAS of both groups decreased,but the difference was not statistically significantRR:0.06,95%CI(-0.03,0.16),P=0.51];Cobb angle before and after surgery in both groups were decreased,but the PKP group decreased more significantly than the PVP groupRR:4.21,95%CI(3.12,5.29)P<0.00001].Average height restoration of vertebral body leading edge rates in both groups were increased,but the PVP group increased more significantly than the PKP groupRR:-14.43,95%CI(-16.85,12.02),P<0.00001].Rates of vertebral compression in both groups were decreased,but the PKP group decreased more significantly than the PVP groupRR:-2.13,95%CI(-3.02,-1.23),P<0.000 01].Conclusion Compared with vertebroplasty in the treatment of thoracolumbar compression fracture,kyphoplasty significantly decreases the rate of vertebral compression;moreover,the average height of vertebral body is restored better.But no significant difference was found in alleviating postoperative pain.