单侧与双侧经皮椎体成形术治疗骨质疏松性椎体压缩骨折有效性与安全性比较的Meta分析  

Meta-analysis of the compairisen of effectiveness and safety of unipedicular versus bipedicular percutaneous vertebroplasty for treating osteoporotic vertebral compression fractures

作　　者：骆洪涛[1] 王金强[1] 闫伟[1] 王浩[1] 郑力通[1] 张旭[1] 武殿伟 

机构地区：[1]解放军空军航空医学研究所附属医院骨科,100089

出　　处：《中华损伤与修复杂志（电子版）》2015年第4期25-29,共5页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

基　　金：全军临床高新技术重大课题项目(2002Z019)

摘　　要：目的通过Meta分析评价单、双侧入路经皮椎体成形术(PVP)治疗骨质疏松性椎体压缩骨折的有效性与安全性。方法计算机检索Cochrane图书馆、Medline、Embase、CNKI、万方数据库和中国生物医学文献数据库,手工检索相关文献的参考文献及主要中英文骨科杂志。收集1980年1月至2015年3月比较单侧和双侧PVP临床疗效与安全性的中、英文随机对照研究,评价纳入研究的方法学质量并提取资料,比较两组患者的手术时间、骨水泥注入量、术后疼痛视觉模拟评分(VAS)及Oswestry功能障碍指数(ODI)评分改善及并发症发生情况。统计软件采用Cochrane协作网提供的Rev Man5.2。结果共检索到相关文献261篇,纳入5项随机对照试验。Meta分析结果显示:与双侧入路PVP相比,单侧入路缩短了手术时间[WMD=-17.28,95%CI(-23.54,-11.03),P<0.01]、减少了骨水泥注入量[WMD=-1.74,95%CI(-2.28,-1.20),P<0.01],但在长期随访中其对患者疼痛VAS评分的改善差于双侧入路[WMD=0.30,95%CI(0.05,0.55),P<0.01];患者术后短期随访VAS疼痛评分、ODI评分及术后并发症发生情况方面二者间差异无统计学意义(P>0.05)。结论单、双侧PVP均可显著缓解患者疼痛,提高患者生活质量,二者安全性相当。单侧入路具有操作时间短、骨水泥注入量少等优点,但其在改善患者术后疼痛的长期疗效方面差于双侧入路。Objective To assess the efficacy and safety of unipedicular versus bipedicular percutaneous vertebroplasty （PVP） for treating osteoporotic vertebral compression fractures. Methods Randomized controlled trials （RCTs） of comparing unipedicular versus bipedicular PVP and relevant references were retrieved in Cochrane library, Medline, Embase, CNKI, Wanfang Data and Chinese Biomedical Database by computer, and major orthopedic journals by hand. Meta-analysis was done to compare operation time, amount of cement injected, visual analogue scores （ VAS）, Oswestry disability index （ODI） scores and postoperative complications between the two groups using statistical software Revman 5.2. Results Five RCTs involving 244 cases were included in the Meta-analysis, including 127 cases in unilateral approach and 117 cases in bilateral approach. The results showed that compared with bilateral approach, unilateral approach significantly decreased operation time [ WMD = - 17.28,95 % CI （ - 23.54, - 11.03 ） ,P 〈 0.01 ], amount of cement injected [ WMD = - 1.74,95 % CI（ -2. 28, - 1.20）, P 〈 0.01 ], but had a poorer outcome of VAS scores at long-term follow-up [WMD = 0. 30,95% CI（0. 05,0. 55）, P 〈 0.01]. There was no significantly difference in VAS scores at short-term follow-up, ODI scores and postoperative complications between the two groups （ P 〉 0.05 ）. Conclusion Both approaches could lead to quick pain relief in patients after PVP safely and effectively. Unilateral approach could provide shorter operation time and lower cement volume, but showed poorer pain relief at long-term follow-up.

关 键 词：椎体成形术 骨质疏松 骨折 压缩性 META分析 

分 类 号：R687.3[医药卫生—骨科学]