双膦酸盐对骨质疏松症患者腰椎融合影响的系统评价和Meta分析

摘要

Objective To evaluate the efficacy and safety of bisphosphonates for the treatment of osteoporosis patients with lumbar spinal fusion surgery using a meta-analysis system.Methods Publications from inception to January 2017 concerning bisphosphonates for the treatment of osteoporosis patients with lumbar spinal fusion surgery were retrieved through PubMed,ScienceDirect,Google Scholar,CNKI,VIP and Wanfang resource databases.Data analysis was performed using Stata 11.0 and the literatures that were finally included were analyzed systematically.Results Nine randomized controlled trials were included.Theresult of meta-analysis showed that there were significant differences between the bisphosphonates group and control group in the treatment of osteoporosis patients with lumbar spinal fusion surgery (P ＜ 0.01) for bone fusion (RR =1.138,95％ CI 1.064,1.217),bone mineral density T-score (MD =0.038,95％ CI 0.025,0.052),Oswestry Disability Index (MD =-4.36,95％ CI -6.372,-2.348),bone resorption biochemical marker CTX (MD =-0.401,95％ CI-0.511,-0.291) and visual analog scale (MD =0.940,95％ CI 0.548,1.332).There were no significant differences in bone formation biochemical marker PINP (MD=-4.328,95％ CI-8.954,0.298) and adverse reactions (RR=0.725,95％ CI0.420,1.251) (P =0.067 and P=0.248).Conclusion There was no association between bisphosphonates treatment and nonunion of lumbar spinal bone,and safety is similar to that of the control group.In addition,it can effectively inhibit bone absorption,improve patients' bone mass and degree of postoperative functional recovery.%目的 通过Meta分析系统评价双膦酸盐对骨质疏松症患者腰椎融合的影响.方法 系统检索PubMed、ScienceDirect、Google Scholar、CNKI、VIP和WanFang Data自建库以来到2017年1月的文献,运用Stata1 1.0定量分析纳入的文献.结果 最终有9篇研究符合纳入标准,Meta分析结果显示:双膦酸盐组与对照组的对比中,植骨融合情况[RR=1.138,95％ CI(1.064,1.217)]、终末随访骨密度T值[MD =0.038,95％ CI(0.025,0.052)]、ODI指数[MD=-4.36,95％ CI(-6.372,-2.348)]、骨吸收生化标志物CTX值[MD=-0.401,95％CI(-0.511,-0.291)]、VAS评分[MD=0.940,95％CI(0.548,1.332)]之间差异均有统计学意义(P＜0.01);终末随访术后骨形成生化标志物PINP值[MD=-4.328,95％CI(-8.954,0.298)]、不良反应情况[RR=0.725,95％ CI(0.420,1.251)]之间差异无统计学意义(P=0.067和P=0.248).结论 腰椎术后应用双膦酸盐并不影响骨质疏松症患者的骨融合结果,而且通过治疗能有效抑制骨吸收代谢,改善其骨量和术后功能恢复程度,且与对照组安全性相近.