单侧与双侧椎体后凸成形治疗骨质疏松性椎体骨折的Meta分析

摘要

背景:微创手术是治疗老年性骨质疏松性椎体骨折的主要方式,近年来经皮椎体后凸成形术在全国迅速普及.但传统的双侧椎弓根穿刺具有手术时间长、成本高等缺点,因此单侧椎弓根穿刺逐渐被应用于临床,但对于单侧与双侧椎体后凸成形的远期临床疗效仍存在一定争议.目的:用Meta分析的方法评价单侧与双侧椎体后凸成形治疗骨质疏松性椎体骨折的有效性与安全性.方法:计算机检索PubMed、Cochrane Library、Embase、Engineering Village、Web of Science、Wiley、OVID数据库、谷歌学术、万方数据库、知网数据库、维普数据库,检索单侧与双侧椎体后凸成形治疗骨质疏松性椎体骨折的随机对照试验并进行Meta分析;检索年限及语种不限.由2名评价员对所有检索的文献按照纳入及排除标准筛选文献,用改良的Jadad量表评价文献质量后采用Review Manager 5.2软件进行Meta分析.结果与结论:①最终纳入11篇随机对照试验,共956例患者,其中单侧组483例,双侧组473例,比例1:1;②Meta分析显示,在手术时间方面,单侧入路明显优于双侧入路[MD=-20.38,95%CI(-24.10,-16.65),P<0.00001];在术中患者接受X射线的时间、剂量方面,单侧入路均少于双侧入路;在骨水泥使用量方面,单侧入路少于双侧入路(P < 0.00001);在术后并发症发生率上,单侧入路发生骨水泥渗漏小于双侧入路(P=0.005);但在术后长期随访中两种手术方式在目测类比评分、椎体高度恢复、伤椎后凸角、相邻椎体再骨折率方面差异无显著性意义;③结果提示,与双侧椎体后凸成形相比,单侧椎体后凸成形治疗骨质疏松性椎体骨折具有手术时间短、术中X射线辐射剂量少、骨水泥渗漏发生率低的优点,因此单侧入路椎体后凸成形治疗骨质疏松性椎体骨折更为安全.%BACKGROUND: Minimally invasive surgery is the main method for senile osteoporotic vertebral fractures, and percutaneous kyphoplasty (PKP) has been rapidly popularized. As the conventional bilateral transpedicular puncture needs a longer operationrntime and higher costs, unilateral transpedicular puncture is gradually applied in clinic. However, the long-term clinical efficacy of unilateral andrnbilateral PKP remains controversial.rnOBJECTIVE: To evaluate the effectiveness and safety of unilateral and bilateral PKP for osteoporotic vertebral fractures through arnmeta-analysis.rnMETHODS: A computer-based retrieval of PubMed, Cochrane Library, Embase, Engineering Village, Web of Science, Wiley, OVID, Google Scholar, WanFang, CNKI and VIP databases was performed for the randomized controlled trials of unilateral and bilateral PKP for osteoporotic vertebral fractures through meta-analysis. Date and language of studies were not limited. Two reviewers screened the retrieved studies in accordance with the inclusion and exclusion criteria. The quality of the studies was evaluated by a modified Jadad scale prior to the meta-analysis on Review Manager 5.2 software.RESULTS AND CONCLUSION: (1) Finally, 956 patients from 11 randomized controlled trials were included and divided into two groups,unilateral group (n=483) and bilateral group (n=473) (1:1). (2) The meta-analysis results showed that the operation time in the unilateral group was significantly better than that in the bilateral group (MD=-20.38, 95%CI(-24.10, -16.65), P < 0.000 01); the dose and duration of intraoperative radiation exposure to the patients in the unilateral group were less than those in the bilateral group; the bone cement used in the unilateral group was significantly less than that in the bilateral group (P < 0.000 01); the incidence of bone cement leakage in the unilateral group was less than that in the bilateral group (P=0.005); there were no significant differences in the Visual Analogue Scale scores, vertebral height restoration, Cobb angle of the fractured vertebra and re-fracture rate of the adjacent vertebrae between two groups during long-term follow-up. (3) Compared with bilateral PKP, unilateral PKP exhibits a shorter operation time, less intraoperative radiation exposure and a lower incidence of bone cement leakage in the treatment of osteoporotic vertebral fractures, so it is a safer surgical method.