经皮椎体成形术联合射频消融治疗脊柱转移瘤效果和安全性Meta分析  

Percutaneous vertebroplasty combined with radiofrequency ablation for spinal metastases:a meta-analysis of clinical efficacy and safety

作　　者：刘仲源 魏传付 李念虎[2] LIU Zhongyuan;WEI Chuanfu;LI Nianhu(Shandong University of Traditional Chinese Medicine,Jinan,Shandong Province 250355,China)

机构地区：[1]山东中医药大学 [2]山东中医药大学附属医院脊柱脊髓科

出　　处：《介入放射学杂志》2024年第10期1088-1094,共7页Journal of Interventional Radiology

基　　金：山东省自然科学基金(ZR20203MH063)。

摘　　要：目的探讨经皮椎体成形术(percutaneous vertebroplasty,PVP)联合射频消融(radiofrequency ablation,RFA)治疗脊柱转移瘤效果和安全性。方法检索2009年5月至2022年7月中国知网(CNKI)、万方、中国生物医学文献数据库(CBM)、PubMed、Cochrane Library、Web of science等数据库中所有关于PVP联合RFA治疗脊柱转移瘤的病例对照试验和随机对照试验研究文献,设对照组(单纯PVP治疗)和试验组(PVP联合RFA治疗)。采用Newcastle-Ottawa量表(NOS)评分评价病例对照试验研究文献,Cochrane风险偏倚评估工具评价随机对照试验研究文献。结果共纳入12篇文献(10篇病例对照试验,2篇随机对照试验)1051例患者。Meta分析显示,试验组与对照组相比可显著减少脊柱转移瘤复发(OR=0.17,95%CI=0.08~0.34,P<0.001),减少并发症发生(OR=0.29,95%CI=0.21~0.41,P<0.001),降低疼痛视觉模拟评分(VAS)(WMD=-1.21,95%CI=-1.64~-0.78,P<0.001),改善Karnofsky功能状态(KPS)评分(WMD=14.69,95%CI=-12.25~17.14,P<0.001),但提升远期疗效并不显著(OR=1.55,95%CI=0.90~2.68,P=0.12)。结论PVP联合RFA治疗脊柱转移瘤具有显著的临床近期效果和安全性,但远期效果并不显著。受限于纳入文献数量和质量,以上结论还需更大规模、更高质量临床试验研究。Objective To investigate the clinical efficacy and safety of percutaneous vertebroplasty(PVP)combined with radiofrequency ablation(RFA)for spinal metastases.Methods A computerized retrieval of academic papers concerning the case-control studies(CCS)and randomized controlled trials(RCT)of PVP combined with RFA for spinal metastases from the databases of CNKI,Wanfang,Chinese Biomedical Literature Database(CBM),PubMed,Cochrane Library,Web of science and other databases was conducted.A control group(receiving PVP treatment alone)and a test group(receiving PVP combined with RFA treatment)were established.Newcastle-Ottawa scale(NOS)score was used to evaluate case-controlled trial literature,and the Cochrane risk bias assessment tool was used to evaluate the RCT literature.Results A total of 12 articles(10 CCS articles and 2 RCT articles)including 1051 patients were included in this analysis.Meta-analysis showed that the recurrence rate of spinal metastases(OR=0.17,95%CI=0.08-0.34,P<0.001),incidence of complications(OR=0.29,95%CI=0.21-0.41,P<0.001)and pain visual analog scale(VAS)score(WMD=-1.21,95%CI=-1.64--0.78,P<0.001)in the test group were significantly lower than those in the control group.The Karnofsky functional status(KPS)score(WMD=14.69,95%CI=-12.25-17.14,P<0.001)in the test group was remarkably higher than that in the control group,but the long-term efficacy in the test group(OR=1.55,95%CI=0.90-2.68,P=0.12)was not obviously better than that in the control group.ConclusionFor the treatment of spinal metastases,PVP combined with RFA has significant clinical short-term efficacy and safety,although its long-term efficacy is not obvious.Due to the limited quantity and quality of the included literature,larger-scale and higher-quality clinical trial studies need to be done before the above conclusions can be further clarified.

关 键 词：骨 脊柱 经皮椎体成形术 射频消融 肿瘤 骨转移 META分析 

分 类 号：R738.1[医药卫生—肿瘤]