中国组织工程研究

中国组织工程研究 ›› 2019, Vol. 23 ›› Issue (10): 1633-1640.doi: 10.3969/j.issn.2095-4344.1637

• 生物材料循证医学 evidence-based medicine of biomaterials • 上一篇    

单侧与双侧椎弓根入路注入骨水泥治疗骨质疏松性椎体压缩骨折有效和安全性的Meta分析

王延涛1，陈 怡2，潘美均2，黄嘉华2，陈锦钊1，刘德坚1，冼淑仪1，周 驰3，王海彬3   

  1. 1广州市番禺区中医院，广东省广州市 511400；2广州中医药大学第一临床医学院，广东省广州市 510405；3广州中医药大学第一附属医院，广东省广州市 511400
  • 收稿日期:2018-11-26
  • 通讯作者: 周驰，博士，主治医师，广州中医药大学第一附属医院，广东省广州市 511400
  • 作者简介:王延涛，男，1980年生，硕士，副主任中医师，主要从事脊柱及关节退行性疾病方面的研究。
  • 基金资助:

    国家自然科学基金(81373655)，项目负责人：王海彬；广东省自然科学基金(2015A030310203)，项目负责人：周驰；广东省高水平大学建设项目(A1-AFD018171Z11057)，项目负责人：周驰；广州中医药大学第一附属医院人才培优项目(2015QN01)，项目负责人：周驰

Efficacy and safety of bone cement injection via unipedicular and bipedicular approaches in the treatment of osteoporotic vertebral compression fractures: a Meta-analysis

Wang Yantao1, Chen Yi2, Pan Meijun2, Huang Jiahua2, Chen Jinzhao1, Liu Dejian1, Xian Shuyi1, Zhou Chi3, Wang Haibin3   

  1. 1Panyu Hospital of Chinese Medicine, Guangzhou 511400, Guangdong Province, China; 2First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China; 3First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 511400, Guangdong Province, China
  • Received:2018-11-26
  • Contact: Zhou Chi, MD, Attending physician, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 511400, Guangdong Province, China
  • About author:Wang Yantao, Master, Associate chief physician, Panyu Hospital of Chinese Medicine, Guangzhou 511400, Guangdong Province, China
  • Supported by:

    the National Natural Science Foundation of China, No. 81373655 (to WHB); the Natural Science Foundation of Guangdong Province, No. 2015A030310203 (to ZC); High-Level University Construction Project of Guangdong Province, No. A1-AFD018171Z11057 (to ZC); the Talent Culture Program of the First Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 2015QN01 (to ZC)

PDF

89

摘要：

文章快速阅读：

 

文题释义：
骨质疏松压缩骨折：是骨质疏松症的严重后果，由于骨量减低、骨强度下降、骨脆性增加，日常活动中由轻微损伤即可造成脆性骨折，此类骨折多属于完全骨折，患者的生活质量明显受到影响，并有较高的致残率及致死率，该病治疗方法包括保守疗法和手术疗法，目前开展较成熟的微创手术主要为文章所探讨的经皮椎体成形术。 
Meta分析：是用统计的概念与方法，去收集、整理与分析之前学者专家针对某个主题所做的众多实证研究，希望能够找出该问题或所关切的变量之间的明确关系模式，可弥补传统的文献综述的不足。文章基于Meta分析的方法，收集有关单侧与双侧椎弓根入路注入骨水泥治疗骨质疏松性椎体压缩性骨折的研究，旨在比较两种不同的手术路径的有效性和安全性。
 
 
背景：采用经皮椎体成形术治疗骨质疏松性椎体压缩骨折时，对于单侧与双侧椎弓根入路注入骨水泥的有效性和安全性仍存在争议，部分研究认为单侧椎弓根入路能够缩短手术时间并减轻术后并发症；另有部分研究认为双侧椎弓根入路能使骨水泥更为均匀地分布于椎体内，可更好地缓解疼痛。
目的：系统评价单侧对比双侧椎弓根入路注入骨水泥治疗骨质疏松性椎体压缩骨折的有效性及安全性。
方法：电子检索 PubMed、Cochrane library、Embase、CNKI、VIP、万方和CBM等数据库，搜索有关单侧椎体成形术对比双侧椎体成形术治疗骨质疏松性椎体压缩骨折的随机对照试验，设定文献发表时间为建库至2018-09-18。对所有符合纳入标准的临床研究进行资料提取，由2名研究员以改良后的Jadad量表独立严格地进行纳入研究的质量评价，应用Revman 5.3软件完成Meta分析。采用Egger’s检验进行发表偏倚的检验。

结果与结论：共纳入14个随机对照试验，包括900例患者，其中单侧入路组452例，双侧入路组448例。Meta分析结果显示：相对于双侧入路组，单侧入路所需要的手术时间更短[WMD=-16.59，95%CI(-19.25，-13.94)，P < 0.001]、骨水泥注入量更少[WMD=-1.27，95%CI(-1.64，-0.89)，P < 0.001]、术后骨水泥渗漏率更低[RR=0.70，95%CI(0.53，0.92)，P=0.01]；两组术后短期与长期目测类比评分、术后短期与长期功能障碍评分及术后邻近椎体骨折发生率比较差异均无显著性意义(P > 0.05)。结果表明，2种手术方式都能有效缓解骨质疏松性椎体压缩骨折患者的疼痛症状，提高患者生活质量，但单侧椎弓根入路具有手术时间短、骨水泥注入量少、骨水泥渗漏率低的优点。

ORCID: 0000-0002-7613-692X(王延涛)；0000-0001-5847-8355(周驰)

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

关键词: 骨水泥, 椎体成形术, 骨质疏松, 压缩性骨折, 单侧椎弓根入路, 双侧椎弓根入路, 目测类比评分, Meta分析

Abstract:

BACKGROUND: In the treatment of osteoporotic vertebral compression fractures with percutaneous vertebroplasty, the efficacy and safety of bone cement injection by unipedicular and bipedicular approaches are still controversial. Some studies suggest that bone cement injection via unipedicular approach can shorten operation time and reduce postoperative complications, while the other studies suggest that bone cement injection via bipedicular approach can make bone cement distribute more evenly in the vertebral body and relieve pain better.

OBJECTIVE: To systematically assess the efficacy and safety of percutaneous vertebroplasty via unipedicular versus bipedicular approach in the treatment of osteoporotic vertebral compression fractures. 
METHODS: Randomized controlled trials about unipedicular versus bipedicular percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fracture published before September 18th, 2018 were retrieved in the PubMed, Cochrane library, Embase, CNKI, VIP, WanFang data and CBM. Two researchers independently screened all the literatures, carried out data extraction and used improved Jadad to evaluate the methodological quality of the included studies. Meta-analysis using Revam 5.3 was conducted. Egger’s test was utilized to evaluate the publication bias.

RESULTS AND CONCLUSION: Totally 14 randomized controlled trials including 900 cases were eventually included, 452 cases in unipedicular approach group and 448 cases in bipedicular approach group. The Meta-analysis results showed that compared with the bipedicular approach, the unipedicular approach required shorter operation time [weighted mean difference (WMD)=-16.59, 95% confidence interval (CI) (-19.25, -13.94), P < 0.001], smaller amount of bone cement injected [WMD=-1.27, 95% CI (-1.64, -0.89), P < 0.001], and had lower incidence of cement leakage [relative risk=0.70, 95% CI (0.53, 0.92), P =0.01]. There were no significant differences in short- and long-term Visual Analogue Scale scores, short- and long-term Oswestry Disability Index scores, and the postoperative incidence of adjacent vertebral fractures between the two groups (P > 0.05). Overall, bone cement injection both via bipedicular and unipedicular approaches can lead to a significant improvement in pain relief and living quality of osteoporotic vertebral compression fracture patients, but bone cement injection via unipedicular approach can shorten operation time, reduce cement volume and lower the incidence of cement leakage compared with the bipedicular approach.

 

Key words: Percutaneous Vertebroplasty, Osteoporotic Fractures, Meta-Analysis, Tissue Engineering

中图分类号: