高黏度与低黏度骨水泥经皮椎体成形治疗骨质疏松椎体压缩性骨折的Meta分析  

A Meta-analysis on percutaneous vertebroplasty with high-viscosity and low-viscosity bone cement for osteoporotic vertebral compression fractures

作　　者：徐敏 张鸿升 王继 唐福宇 黄承军 梁冬波 薛鸿 徐宝山[2] 

机构地区：[1]柳州市中医医院骨伤科,广西壮族自治区柳州市545000 [2]天津市天津医院脊柱外科,天津市300211

出　　处：《中国组织工程研究》2017年第34期5571-5576,共6页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金资助项目(81272046;31670983)~~

摘　　要：背景:经皮椎体成形术治疗骨质疏松性椎体压缩性骨折的疗效已得到肯定,但骨水泥渗漏导致的相关并发症仍时有发生。目的:系统评价经皮椎体成形术中使用高黏度和低黏度骨水泥治疗骨质疏松椎体压缩性骨折的安全性和并发症。方法:通过计算机检索PubMed、Cochrane Library(2016年12月)、Embase、以及中国知网、维普期刊数据库、万方资源数据库、中国生物医学文献服务系统,检索年限从2000年1月至2016年12月,同时手工检索相关的中英文骨科杂志。收集使用高黏度和低黏度骨水泥治疗骨质疏松椎体压缩骨折的随机对照试验,然后按Cochrane协作网推荐的方法进行系统评价。利用国际Cochrane协作网为系统评价工作者所提供的专用软件RevMan 5.2进行Meta分析。结果与结论:①共纳入6篇文献,均为经皮椎体成形术中使用高黏度和低黏度骨水泥治疗骨质疏松椎体压缩性骨折的随机对照试验,患者共554例,其中使用高黏度骨水泥278例,低黏度骨水泥276例;②2组病例术后疼痛症状均得到缓解,在术后邻近椎体骨折方面,2组患者差异无显著性意义(P>0.05);③但在改善目测类比评分、Oswestry功能障碍指数、椎体后凸Cobb角与预防骨水泥渗漏发生率方面,经皮椎体成形术高黏度骨水泥组优于低黏度骨水泥组(P<0.05);④Meta分析结果显示,经皮椎体成形术中使用高黏度和低黏度骨水泥修复骨质疏松椎体压缩骨折均可迅速缓解患者疼痛症状,皆为安全有效的治疗方法;但与低黏度骨水泥相比,高黏度骨水泥在改善术后目测类比评分、Oswestry功能障碍指数、椎体后凸Cobb角与预防骨水泥渗漏方面更具优势。BACKGROUND： Percutaneous vertebroplasty （PVP） has been proved to be effective for osteoporotic vertebralcompression fractures （OVCF）; however, bone cement leakage-related complications occur frequently.OBJECTIVE： To systematically evaluate the safety and complications of PVP with high-viscosity and low-viscosity bonecement in the treatment of OVCF.METHODS： We performed a systematic search by computer in PubMed, EMBASE, Cochrane Library （December, 2016）and CNKI, CBM, VIP and WanFang databases from January, 2000 to December, 2016; meanwhile, the relevant Chineseand English orthopedic journals were retrieved manually. Randomized controlled trials （RCTs） concerning the use ofhigh-viscosity and low-viscosity bone cement in the PVP for OVCF were collected and systematically reviewed using themethod recommended by the Cochrane Collaboration. The Meta-analysis was performed by using the RevMan5.2.RESULTS AND CONCLUSION： Six relevant RCTs were included, involving 554 patients （high-viscosity bone cementwas used in 278 cases and low-viscosity bone cement in 276 cases）. Meta-analysis results showed that postoperativepain symptoms were alleviated in all the 554 cases, and there was no significant difference in the amount of adjacentvertebral fractures between two approaches （P 〉 0.05）. However, there was a significant difference in the visual analogscale score, Oswestry disability index value, Cobb angle, and bone cement leakage rate between high-viscosity andlow-viscosity cement groups （P 〈 0.05）. To conclude, PVP with either high-viscosity or low-viscosity bone cement canrelieve pain rapidly in OVCF patients, and both approaches are safe and effective. However, high-viscosity bone cementhas a lower cement leakage rate and better outcomes in visual analog scale score, Oswestry disability index, Cobb angle and cement leakage prevention as compared with low-viscosity bone cement.

关 键 词：椎体成形术 骨质疏松 骨折 压缩性 循证医学 组织工程 生物材料 骨生物材料 高黏度骨水泥 低黏度骨水泥 经皮椎体成形术 压缩骨折 系统评价 国家自然科学基金 

分 类 号：R683.205[医药卫生—骨科学]