椎体后凸成形与椎体成形修复重建胸腰压缩性骨折患者脊柱稳定性的系统评价和Meta分析

目的：利用Meta分析方法对国内应用椎体后凸成形与椎体成形修复重建胸腰压缩性骨折的对照试验进行荟萃分析，从而在较大样本量的前提下评价并比较两种方法修复胸腰压缩性骨折的有效性和安全性。方法：收集中国期刊全文数据库(1998/2008)、中国生物医学数据库及维普期刊网关于椎体后凸成形术与椎体成形术治疗胸腰压缩性骨折的对照文献，对结果进行Meta分析。其中，试验组行椎体后凸成形术，对照组行椎体成形术。疗效及差异评价指标以比值比、加权均数差和95%可信区间(CI)表示。统计学分析采用Review Manager4.2软件。结果：共收集国内8个随机对照研究，Meta分析结果显示，2组病例术后目测类比疼痛评分均降低，但差异无显著性意义[比值比为-0.07，95%CI(-0.35，-0.49)，P=0.75]。2组病例手术前后Cobb角均下降，但试验组较对照组下降更明显 [比值比为-8.60，95%CI(-13.36，-3.83)，P=0.0004]。2组病例手术前后椎体前缘平均高度恢复率均升高, 但试验组较对照组升高更明显[比值比为25.08，95% CI(9.30，40.87)，P=0.002)。2组病例手术前后椎体压缩率均降低，但试验组降低更明显[比值比为-12.04，95%CI(-17.03，-7.04)，P < 0.000 01]。结论：与椎体成形术相比，椎体后凸成形术修复重建胸腰压缩性骨折能够更好地缩小Cobb角，降低椎体压缩率，同时椎体前缘平均高度得以更好的恢复，但两者在缓解术后疼痛方面无明显差异。

System evaluation and Meta analysis of kyphoplasty and vertebroplasty in treatment of thoracolumbar compression fractures

OBJECTIVE: To analyze the contrast experiment of kyphoplasty and vertebroplasty in the treatment of thoracolumbar compression fractures to evaluate and compare the efficacy and safety of two methods.METHODS: Computer-based online search of CNKI (1998/2008), CBM and VIP database was performed to collect contrast studies on kyphoplasty and vertebroplasty in the treatment of thoracolumbar compression fracture, and meta-analysis was performed on the results. Among them, the test group treated with kyphoplasty, while control group with vertebroplasty. Differences in efficacy and evaluation indicators were odds ratio (RR), weighted mean difference and 95% confidence interval (CI). Review Manager4.2 was used for statistical analysis.RESULTS: A total of 8 randomized, controlled domestic researches were collected. Meta analysis showed that postoperative visual analog scale scores of both groups decreased, but the difference was not statistically significant [RR: -0.07, 95% CI (-0.35, -0.49), P = 0.75]; Cobb angle before and after surgery in both groups were decreased, but the test group decreased more significantly than the control group [RR: -8.60, 95% CI (-13.36, -3.83), P = 0.000 4]. Average height restoration of vertebral body leading edge rates in both groups were increased, but the test group increased more significantly than the control group [RR: 25.08, 95% CI (9.30,40.87), P = 0.002). Rates of vertebral compression in both groups were decreased, but the test group decreased more significantly than the control group [RR: -12.04, 95% CI (-17.03, -7.04), P < 0.000 01].CONCLUSION: Compared with vertebroplasty in the treatment of thoracolumbar compression fracture, kyphoplasty significantly decreases the Cobb angle and 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.