[1]吴卓檀,兰荣玉,张卫华,等.椎体支架成形术与经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折有效性和安全性的Meta分析[J].中医正骨,2024,36(04):37-46.
　WU Zhuotan,LAN Rongyu,ZHANG Weihua,et al.Clinical outcomes and safety of vertebral body stenting versus percutaneous kyphoplasty for treatment of osteoporotic vertebral compression fracture:a meta-analysis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2024,36(04):37-46.
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椎体支架成形术与经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折有效性和安全性的Meta分析()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第36卷
期数:
2024年04期
页码:
37-46
栏目:
文献研究
出版日期:
2024-04-20

文章信息/Info

Title:
Clinical outcomes and safety of vertebral body stenting versus percutaneous kyphoplasty for treatment of osteoporotic vertebral compression fracture:a meta-analysis
作者:
吴卓檀1; 兰荣玉2; 张卫华2; 申婷婷1; 韩林轩2; 吴晓飞2; 何炳坤3; 任晓平2
1.广西中医药大学研究生院,广西 南宁 530001; 2.广西中医药大学附属瑞康医院,广西 南宁 530011; 3.广西中医药大学第一附属医院,广西 南宁 530023
Author(s):
WU Zhuotan1; LAN Rongyu2; ZHANG Weihua2; SHEN Tingting1; HAN Linxuan2; WU Xiaofei2; HE Bingkun3; REN Xiao-ping2
1.Postgraduate College of Guangxi University of Chinese Medicine,Nanning 530001,Guangxi,China 2.Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine,Nanning 530011,Guangxi,China 3.The First Affiliated Hospital of Guangxi University of Chinese Medicine,Nanning 530023,Guangxi,China
关键词:
脊柱骨折;  骨质疏松性骨折;  骨折; 压缩性;  后凸成型术;  椎体支架成形术;  专题Meta分析
Keywords:
spinal fractures;  osteoporotic fractures;  fractures; compression;  kyphoplasty;  vertebral body stenting;  meta-analysis as topic
摘要:
目的:系统评价椎体支架成形术(vertebral body stenting,VBS)和经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)的有效性和安全性。方法:应用计算机检索中国知网、万方数据库、维普网、中国生物医学文献服务系统、PubMed、Web of Science、Embase和Cochrane Library中VBS和PKP治疗OVCF的对比研究文献,检索时限均为建库起至2023年12月20日。试验组采用VBS治疗,对照组采用PKP治疗,且均采用双侧椎弓根入路。2名研究人员分别独立进行文献筛选、数据提取和纳入研究的质量评价。采用Stata18.0软件进行Meta分析。结果:共检索到196篇文献,最终纳入10篇文献,共涉及707例患者,其中试验组353例、对照组354例。Meta分析结果显示,试验组的手术时间长于对照组[WMD=9.02,95%CI(2.72,15.32),P=0.005],骨水泥填充量多于对照组[WMD=1.00,95%CI(0.34,1.65),P=0.003],术后伤椎后凸Cobb角、局部后凸Cobb角均小于对照组[WMD=-3.16,95%CI(-5.22,-1.10),P=0.003; WMD=-1.87,95%CI(-2.11,-1.64),P=0.000],术后Beck指数大于对照组[WMD=0.16,95%CI(0.11,0.20),P=0.000],2组术中出血量、住院时间、骨水泥渗漏发生率、其他不良事件发生率的差异均无统计学意义[WMD=0.19,95%CI(-0.18,0.55),P=0.317; WMD=0.09,95%CI(-0.12,0.29),P=0.410; RR=0.96,95%CI(0.69,1.32),P=0.799; RR=0.39,95%CI(0.06,2.34),P=0.301]。结论:现有证据表明,VBS手术时间长于PKP,骨水泥填充量多于PKP,在恢复和维持伤椎正常形态方面优于PKP,二者在术中出血量、住院时间及安全性方面相当。
Abstract:
Objective:To systematically review the clinical outcomes and safety of vertebral body stenting(VBS)versus percutaneous kyphoplasty(PKP)for treatment of osteoporotic vertebral compression fractures(OVCF).Methods:All the comparative study articles about VBS versus PKP for treatment of OVCF included from database's inception to December 20,2023 were retrieved from the China National Knowledge Infrastructure,Wanfang Database,Vip Database,Chinese Biomedical Literature Service System,PubMed,Web of Science,Embase and Cochrane Library through computer.The patients in experiment group were treated with VBS through bipedicular approach,while the ones in control group with PKP through bipedicular approach.The articles were screened,the information was extracted and the methodological quality of included researches in the articles was evaluated independently by two researchers,and then a Meta-analysis was conducted by using Stata18.0 software.Results:One hundred and ninety-six articles were searched out.After screening,10 articles(707 patients)were included in the final analysis,353 patients in experiment group and 354 ones in control group.The results of Meta-analysis revealed that the operative time was longer,the consumption of bone cements was more,the postoperative injured vertebrae kyphosis Cobb's angle and local kyphosis Cobb's angle were smaller,the postoperative Beck index was greater in experiment group compared to control group(WMD=9.02,95%CI(2.72,15.32),P=0.005; WMD=1.00,95%CI(0.34,1.65),P=0.003; WMD=-3.16,95%CI(-5.22,-1.10),P=0.003; WMD=-1.87,95%CI(-2.11,-1.64),P=0.000; WMD=0.16,95%CI(0.11,0.20),P=0.000); while,there was no statistical difference in intraoperative blood loss,hospital stay,incidence rate of bone cement leakage and adverse events between the 2 groups(WMD=0.19,95%CI(-0.18,0.55),P=0.317; WMD=0.09,95%CI(-0.12,0.29),P=0.410; RR=0.96,95%CI(0.69,1.32),P=0.799; RR=0.39,95%CI(0.06,2.34),P=0.301).Conclusion:Available evidences suggest that VBS consumes more operative time and bone cements compared to PKP,while,it outperforms PKP in restoring and maintaining the normal morphology of injured vertebra.However,the both are comparable in intraoperative blood loss,hospital stay,and safety.

参考文献/References:

[1] 中国康复医学会骨质疏松预防与康复专业委员会.骨质疏松性椎体压缩骨折诊治专家共识(2021版)[J].中华医学杂志,2021,101(41):3371-3379.
[2] 孙亦强,邢建强,李雪城,等.椎体后凸成形与椎体成形治疗老年骨质疏松性椎体压缩骨折:椎体高度恢复的比较[J].中国组织工程研究,2021,25(18):2851-2855.
[3] LI Y X,GUO D Q,ZHANG S C,et al.Risk factor analysis for re-collapse of cemented vertebrae after percutaneous vertebroplasty(PVP)or percutaneous kyphoplasty(PKP)[J].Int Orthop,2018,42(9):2131-2139.
[4] 林铖,陈唐亦衡,刘义杰,等.骨质疏松性椎体压缩骨折行经皮椎体后凸成形术后骨水泥渗漏和伤椎再塌陷的危险因素分析[J].中华创伤杂志,2022,38(6):531-537.
[5] 于亮,赵刘军.骨质疏松性椎体压缩骨折手术治疗进展及穿刺并发症[J].中国骨伤,2024,37(1):3-6.
[6] FURDERER S,ANDERS M,SCHWINDLING B,et al.Vertebral body stenting.A method for repositioning and augmenting vertebral compression fractures[J].Orthopade,2002,31(4):356-361.
[7] 王化瑾,王博.经皮椎体后凸成形术中采用椎体支架系统治疗骨质疏松性椎体压缩性骨折[J].脊柱外科杂志,2023,21(2):87-91.
[8] 马延怀,张顺聪,袁凯,等.经皮椎体支架成形和经皮椎体后凸成形治疗骨质疏松性椎体压缩骨折的疗效观察[J].中国组织工程研究,2020,24(14):2170-2176.
[9] SCHUTZENBERGER S,SCHWARZ S M,GREINER L,et al.Is vertebral body stenting in combination with CaP cement superior to kyphoplasty?[J].Eur Spine J,2018,27(10):2602-2608.
[10] 贾璞,陈浩,包利,等.改良支架成形术与经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折近期疗效分析[J].临床和实验医学杂志,2018,17(16):1760-1763.
[11] 夏坤阳,慈元,李志君,等.经皮椎体支架内固定治疗骨质疏松性椎体压缩骨折的临床研究[J].中医正骨,2022,34(8):1-7.
[12] BERGER V W.Is the Jadad score the proper evaluation of trials?[J].J Rheumatol,2006,33(8):1710-1711.
[13] 曾宪涛,庄丽萍,杨宗国,等.Meta分析系列之七:非随机实验性研究、诊断性试验及动物实验的质量评价工具[J].中国循证心血管医学杂志,2012,4(6):496-499.
[14] WERNER C M L,OSTERHOFF G,SCHLICKEISER J,et al.Vertebral body stenting versus kyphoplasty for the treatment of osteoporotic vertebral compression fractures:a randomized trial[J].J Bone Joint Surg Am,2013,95(7):577-584.
[15] 仉培武,郭华,严少荣,等.经皮带球囊支架植入椎体成形术治疗老年骨质疏松性椎体压缩骨折的临床疗效[J].西安交通大学学报(医学版),2022,43(1):63-68.
[16] 蔡进奎,潘和科,周健和,等.钛网植入椎体成形术与PKP治疗脆性骨折疗效比较[J].实用医学杂志,2020,36(9):1228-1232.
[17] 赵中男,刘亚明,陈丽娟,等.经皮椎体支架成形术与经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折疗效比较[J].临床军医杂志,2023,51(3):318-320.
[18] 赵鹏,慈元,李志君,等.经皮椎体支架成形术治疗骨质疏松性椎体压缩骨折[J].中国矫形外科杂志,2022,30(4):314-318.
[19] 马延怀.椎体支架后凸成形术治疗骨质疏松椎体骨折临床疗效与有限元分析[D].广州:广州中医药大学,2021.
[20] 杨柳,杜建伟.椎体增强术中降低骨水泥渗漏发生率的措施[J].中国组织工程研究,2022,26(22):3598-3601.
[21] 崔颖,王宇翔,刘晓伟,等.球囊扩张椎体后凸成形术治疗Kümmell病效果分析[J].中国医学前沿杂志(电子版),2021,13(1):109-112.
[22] 吴贵根,陈宝华.PKP术后骨水泥椎管渗漏与椎体后壁形态的关系研究[J].颈腰痛杂志,2023,44(6):1094-1095.
[23] 袁航,杨永竑,谢亚明.骨质疏松性椎体压缩骨折PKP术后伤椎高度丢失的相关因素分析[J].中国骨与关节损伤杂志,2021,36(5):456-460.
[24] ZHANG J,ZHOU Q,ZHANG Z,et al.Comparison between unilateral and bilateral percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fracture:a meta-analysis and systematic review[J].Exp Ther Med,2023,26(6):553.
[25] MA X,SUN H,LIU S,et al.Cement leakage in vertebral compression fractures between unilateral and bilateral percutaneous vertebral augmentation:a meta-analysis[J/OL].Turk Neurosurg,2022[2023-12-13].https://pubmed.ncbi.nlm.nih.gov/36066059/.
[26] ROTTER R,MARTIN H,FUERDERER S,et al.Vertebral body stenting:a new method for vertebral augmentation versus kyphoplasty[J].Eur Spine J,2010,19(6):916-923.
[27] 吴梓卓.PKP术后椎体高度恢复率和Beck指数与高度丢失率的相关性分析[D].广州:广州中医药大学,2019.
[28] ZHANG W,LIU S,LIU X,et al.Unilateral percutaneous vertebroplasty for osteoporotic lumbar compression fractures:a comparative study between transverse process root-pedicle approach and conventional transpedicular approach[J].J Orthop Surg Res,2021,16(1):73.
[29] LIEBSCHNER M A,ROSENBERG W S,KEAVENY T M.Effects of bone cement volume and distribution on vertebral stiffness after vertebroplasty[J].Spine(Phila Pa 1976),2001,26(14):1547-1554.
[30] 张嘉.骨质疏松性椎体压缩骨折的微创强化治疗[J].中华骨与关节外科杂志,2021,14(5):350-354.
[31] VENDEUVRE T,BROSSARD P,PIC J B,et al.Vertebral balloon kyphoplasty versus vertebral body stenting in non-osteoporotic vertebral compression fractures at the thoracolumbar junction:a comparative radiological study and finite element analysis(BONEXP study)[J].Eur Spine J,2021,30(10):3089-3098.

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备注/Memo

备注/Memo:
基金项目:国家自然科学基金项目(82060874); 广西重点研发计划项目(桂科ZY21195041) 通讯作者:任晓平 E-mail:chinarenxg@126.com
更新日期/Last Update: 1900-01-01