单侧与双侧经皮椎体后凸成形修复骨质疏松椎体压缩性骨折的Meta分析

摘要

BACKGROUND:Percutaneous kyphoplasty, as a kind of minimal y invasive surgery, has been proved to be effective in the treatment of osteoporotic vertebral compression fractures. Percutaneous kyphoplasty has simple operation and safe mode, can relieve pain quickly, and obviously restore vertebral body height. However, the therapeutic effects of unipedicular and bipedicular percutaneous kyphoplasty for osteoporotic vertebral compression fractures are controversial. n OBJECTIVE:To analyze control ed trials on the therapy with unipedicular and bipedicular percutaneous kyphoplasty using meta-analysis, and to compare the effectiveness and superiority of the two methods with a large sample size. n METHODS:We retrieved PubMed, Web of Knowledge, China Journal Ful-text database, Wanfang database, and Super Star database for articles on meta-analysis of unipedicular versus bipedicular percutaneous kyphoplasty published from 2000 to 2014 in Chinese and English. Unipedicular percutaneous kyphoplasty served as experimental group and bipedicular percutaneous kyphoplasty as control group. Curative effect and the difference between evaluation indexes were expressed as the weighted mean difference and 95%confidence interval and the RR value. Statistical analysis was carried out using Review Manager 5.2 software. n RESULTS AND CONCLUSION:A total of seven randomized control ed trials were col ected. Results of statistical analysis showed that visual analogus scale scores were decreased in both groups, but no significant difference was detected [RR=-0.08, 95%CI(-0.05,-0.21), P=0.21]. There was no significant difference in Cobb angle change [RR=-0.07, 95%CI(-0.16,-1.47), P=0.93]. No significant difference in the average recovered height of vertebral bodies was detected [RR=-1.76, 95%CI(-4.21, -0.69), P=0.16]. Operation time was shorter in unipedicular percutaneous kyphoplasty than in bipedicular percutaneous kyphoplasty [RR=-23.99, 95%CI(-26.01, -21.97), P<0.000 01]. These data indicated that compared with bipedicular percutaneous kyphoplasty, unipedicular percutaneous kyphoplasty could effectively reduce the operation time. However, no significant difference in visual analogus scale scores, Cobb angle change and the average recovered height of vertebral bodies was visible in statistical analysis in both groups.%背景：经皮椎体后凸成形治疗作为一种微创手术治疗骨质疏松椎体压缩性骨折证明是有效的，其具有简便的手术操作，安全的模式，能迅速缓解疼痛，明显恢复椎体高度。但目前对于单侧与双侧经皮椎体后凸成形治疗骨质疏松椎体压缩性骨折的效果还存在争议。n　　目的：利用Meta分析对于国内外应用单侧与双侧经皮椎体后凸成形治疗的对照试验进行荟萃分析，在样本量较大的前提下比较和评价两种治疗方案的有效性与优越性。n　　方法：收集PubMed、Web of Knowledge、中国期刊全文数据库、万方医学数据库、超星数据库关于单侧经皮椎体后凸成形与双侧经皮椎体后凸成形治疗的对照文献进行Meta分析，纳入语种包括中文、英文，时限设定在2000至2014年，其中单侧经皮椎体后凸成形治疗为试验组，双侧经皮椎体后凸成形治疗为对照组；疗效及差异评价指标以加权均数差和95%可信区间(CI)、RR值表示，运用Review Manager5.2软件进行统计分析。n　　结果与结论：共收集到国内外7篇随机对照试验，统计分析结果显示，2组病例目测类比评分均降低，但差异无显著性意义[RR=-0.08，95%CI(-0.05，-0.21)，P=0.21]；Cobb角变化差异无显著性意义[RR=-0.07，95%CI(-0.16，-1.47)，P=0.93]；椎体平均高度恢复比较差异无显著性意义[RR=-1.76，95%CI(-4.21，-0.69)，P=0.16]；单侧经皮椎体后凸成形治疗的手术时间较双侧经皮椎体后凸成形短[RR=-23.99，95%CI(-26.01，-21.97)，P<0.00001]。提示与双侧经皮椎体后凸成形治疗相比，单侧经皮椎体后凸成形治疗能有效减少手术操作时间；但在目测类比评分、Cobb角变化、椎体平均高度恢复方面两者在统计学范畴无明显差异。