经皮椎体成形和经皮椎体后凸成形治疗国人胸腰椎压缩性骨折疗效及安全性的Meta分析

背景：经皮椎体成形和经皮椎体后凸成形治疗胸腰椎压缩性骨折在国内外均积累了相当多的临床经验,但尚缺乏循证医学方面的依据。目的：采用Meta分析评价经皮椎体成形和经皮椎体后凸成形治疗胸腰椎压缩性骨折的疗效以及安全性。方法：搜集国内应用经皮椎体成形和经皮椎体后凸成形对比治疗胸腰椎压缩性骨折的文献,并追查已纳入文献的参考文献。由至少两位系统评价员做独立文献筛查、质量评价和资料提取,并交叉核对,不同意见请第三者裁决。使用统计软件RevMan 5.0完成Meta分析。结果与结论：经筛选,最后纳入7篇文献进行Meta分析,包括受试患者398例,其基线情况一致,具有可比性。5篇文献的随访时间为6周,2篇为4周。结果提示,经皮椎体成形和经皮椎体后凸成形均是治疗国人胸腰椎压缩性骨折的有效方法,且在改善目测类比评分方面差异无显著性意义(P > 0.05);在改善Cobb角及治疗后骨水泥渗漏发生率方面,经皮椎体后凸成形均优于经皮椎体成形(P < 0.001,P=0.05)。因纳入文献和样本量有限,建议进行大样本、长期随访的高质量临床试验,提供更佳循证证据。

Effect and safety of percutaneous vertebroplasty and percutaneous kyphoplasty for thoracic and lumbar vertebral compression fractures: A Meta-analysis

BACKGROUND:There are many clinical experiences for percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in treatment of thoracic and lumbar vertebral compression fractures; however, relevant evidence-based medicine studies are rare. OBJECTIVE:To systematically review and evaluate the effectiveness and safety of PVP and PKP for treating thoracic and lumbar vertebral compression fractures. METHODS:Chinese studies were sought and included in the review if they were randomized controlled trials concerning PVP versus PKP for thoracic and lumbar vertebral compression fractures. Two reviewers independently screened the studies for eligibility, evaluated the quality and extracted the data from the eligible studies, with confirmation by cross-checking. Divergences of opinion were settled by discussion or consulted by the expert. Data were processed by RevMan 5.0.RESULTS AND CONCLUSION:Seven studies involving 398 patients met the inclusion criteria. The baseline of patients’ characteristics was comparable in all the studies. The follow-up duration was 4 or 6 weeks. There was no significant difference to improve VAS score; but it was significant for the improvement of the Cobb angle (P < 0.001); Compared with PKP, the incidence of postoperative leakage of bone cement after PVP was lower (P = 0.05). Because of few studies and small samples, more high quality trials with large samples and longer following-up are proposed.