椎体强化术治疗骨质疏松性椎体压缩性骨折的争议与分析  

Controversy and analysis of vertebral augmentation for osteoporotic vertebral compression fracture

作　　者：魏子恒 宋滇文 Wei Ziheng;Song Dianwen(Department of Orthopaedics,Shanghai General Hospital,Affiliated to Shanghai Jiaotong University,Shanghai 201620,China)

机构地区：[1]上海交通大学附属第一人民医院骨科,201620

出　　处：《中华骨科杂志》2020年第20期1420-1428,共9页Chinese Journal of Orthopaedics

摘　　要：虽然椎体强化术被广泛应用于骨质疏松性椎体压缩性骨折的治疗,但该手术的临床疗效却始终饱受争议。自2009年至今,共有4项高质量的前瞻性随机双盲假手术对照研究相继发表,其关于椎体强化术有效性的结论却并不一致。2018年的Cochrane系统评价以及2019年美国骨与矿物质研究学会的专项工作报告都认为椎体强化术与假手术相比并无优势,不支持常规用于骨质疏松性椎体压缩性骨折的治疗,这又引发了新一轮争论,使得椎体强化术的有效性问题更加扑朔迷离,难以指导外科医生的实际临床工作。回顾争议中的关键研究,对争议中的细节问题以及最新观点进行了梳理、分析,概述了椎体强化术对于骨质疏松性椎体压缩性骨折患者死亡率的影响,并基于当前证据,提出了椎体强化术的优化应用模式。Vertebral augmentation(VA)is widely used in the clinical treatment of osteoporotic vertebral compression fracture(OVCF),but its clinical efficacy has always been controversial.Since 2009,a total of four high-quality prospective randomized double-blind placebo-controlled studies have been published,but their conclusions on the effectiveness of VA were inconsistent.Latest Cochrane review(2018)and American society for bone and mineral research task report(2019)believed that compared with sham surgery,there is no advantage supporting the use of VA as a routine treatment for patients with OVCF,which triggered a new round of debates.The effectiveness of the VA remains to be determined,which makes it difficult to guide the actual clinical work of surgeons.This paper reviews the key studies in the controversy,sorts out and analyzes the details and latest views in the controversy,summarizes the impact of VA on the mortality rate of OVCF patients,and puts forward the optimal application mode of VA based on the current evidence.

关 键 词：骨质疏松性椎体压缩性骨折 椎体强化术 COCHRANE系统评价 临床疗效 有效性问题 外科医生 专项工作 优化应用 

分 类 号：R687.3[医药卫生—骨科学]