Two surgical methods for osteoporotic vertebral compression fractures: a meta-analysis on safety and efficacy

doi:10.3969/j.issn.2095-4344.2014.22.019

Abstract

Abstract:

BACKGROUND: Percutaneous kyphoplasty and percutaneous vertebroplasty are effective safe minimally invasive treatment methods for osteoporotic vertebral compression fracture. Percutaneous kyphoplasty has a certain advantage on long-period pain release, incidence rate of bone cement leakage, vertebral height recovery, and long-term kyphotic angle reduction compared with percutaneous vertebroplasty. However, we cannot deny the effects of percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fracture.

OBJECTIVE: A meta-analysis was performed to assess the safety and efficacy of percutaneous kyphoplasty and percutaneous vertebroplasty for treating osteoporotic vertebral compression fractures.

METHODS: A systematic computer-based search of all studies published till May 2013 was conducted in PubMed, Web of science, Ovid medline, Embase, Cochrane central database and CNKI for controlled studies concerning percutaneous kyphoplasty and percutaneous vertebroplasty in treatment of osteoporotic vertebral compression fracture. Study selection was done by two reviewers independently according to inclusion and exclusion criteria. Meta analysis was performed using Revman5.2 (5.2.5 edition) software provided by Cochrane Collaboration.

RESULTS AND CONCLUSION: A total of 12 studies containing 1 081 patients were included. The results of meta-analysis indicated that there were no significant differences between the two groups in the short-term pain relief, short-term and long-term Oswestry Dability Index scores, incidence of adjacent-level fracture, short-term restoration of kyphosis angle and operation time (P > 0.05). However, there were significant differences in the long-term pain relief, the incidence of cement leakage, postoperative anterior vertebral heights and long-term restoration of kyphosis angle (P < 0.05). Results suggested that percutaneous kyphoplasty was superior to percutaneous vertebroplasty in the long-term pain relief, the incidence of cement leakage, restoration of postoperative anterior vertebral body and long-term restoration of kyphosis angle. Percutaneous kyphoplasty and percutaneous vertebroplasty both are safe and effective surgical procedures. Due to lack of high-quality randomized controlled trails in the original studies, more randomized controlled trails are required and a prudent choice is suggested.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: vertebroplasty, fractures, compression, osteoporotic fractures, Meta-analysis

CLC Number:

R318

Mahmootjan•Muhammat, Zhu Shao-bo, Li Jing-feng, Jin Lin, Su Ri-han, Wang Xi. Two surgical methods for osteoporotic vertebral compression fractures: a meta-analysis on safety and efficacy[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(22): 3551-3559.

Figures/Tables 7

2.3 Meta分析统计学结果 2.3.1 缓解疼痛差异所有12个研究中11个研究提供了经皮椎体后凸成形技术和经皮椎体成形技术治疗前后疼痛目测类比评分[21-23，25-32]。其中有7个研究报道两种治疗方式对短期(治疗后1周内)疼痛缓解进行分析[21-23，25，27-28,30]。纳入研究间存在异质性(P < 0.000 01，I2=94%)，故采用随机效应模型合并分析。Meta分析结果显示，经皮椎体后凸成形技术与经皮椎体后凸成形技术在短期内缓解疼痛差异无显著性意义(MD=-0.57，95%CI=-1.33，0.20；P=0.15)(图3)。对此进行敏感性分析发现，分别剔除7项研究，各合并效应量均无本质性改变，且森林图方向未改变，说明该研究结果较可靠、稳定。有10个研究报道两种治疗方式对长期(治疗后6个月或更长时间)疼痛缓解进行分析[21，23，25-32]。各研究间有异质性(P < 0.000 01，I2=98%)，故采用随机效应模型合并分析。Meta分析结果表明：两种治疗方式长期缓解疼痛差异有显著性意义(MD=-1.06，95%CI=-2.01，-0.10；P=0.03)(图4)，经皮椎体后凸成形技术组治疗后长期疼痛缓解方面优于经皮椎体成形技术组。去除任一项研究进行敏感性分析发现，各合并效应量仍都具有显著性意义，森林图方向未改变，说明该研究结果可信度大。 2.3.2 改善患者功能障碍方面差异在5个研中提到治疗前及治疗后的功能障碍指数[23，25-26，28-29]，2个研究具有充足的短期功能障碍指数[25，28]，各研究间有异质性(P < 0.002，I2=90%)，采用随机效应模型合并分析。统计学分析结果示，两种治疗方法在短期内改善患者功能障碍方面差异无显著性意义(MD=-6.54，95%CI=-14.57，1.48；P=0.11)(图5)。敏感性分析发现，分别剔除5项研究，各合并效应量均未出现本质性改变，且森林图方向未改变，说明该研究结果可靠。共有5个研究提供了远期功能障碍指数[23，25-26，28-29]。各研究间有异质性(P < 0.000 01，I2=94%)，采用随机效应模型合并分析。Meta分析结果表明：两种治疗方法远期改善患者功能障碍的差异也无显著性意义(MD=-2.01，95%CI=-11.75，7.73；P=0.69)(图6)。敏感性分析结果示，分别剔除5项研究，各合并效应量均未出现本质性改变，且森林图方向未改变，说明该研究结果可靠。 2.3.3 骨水泥渗漏发生率的差异有11个研究给出了骨水泥渗漏有关的数据[22-32]。各研究间有较好的同质性(P=0.29，I2=17%)，故采用固定效应模式进行统计学分析。Meta分析结果示，两种方法治疗后骨水泥渗漏的发生率差异有显著性意义(RR=0.65，95%CI=0.47，0.89；P=0.007，图7)。经皮椎体后凸成形组较经皮椎体成形组具有较低的骨水泥渗漏发生率的优势。 2.3.4 相邻椎体骨折发生率的差异共有8个研究报道了治疗后发生相邻椎体骨折相关的数据[21，23，25-28，30-31]。各研究间有同质性(P=0.41，I2=2%)，故采用固定效应模式进行统计学分析。Meta分析结果表明：两种方法治疗后相邻椎体骨折发生率的比较差异无显著性意义(RR=0.90，95%CI=0.53，1.53；P=0.71)(图8)。"

2.3.5 椎体前缘高度的恢复程度的差异有4个研究提供了治疗前后病患椎体前缘高度恢复情况[21，28- 29，32]。研究间有较大的异质性(P < 0.000 01，I2=96%)，采用随机效应模型合并分析。Meta分析结果表明：治疗后椎体高度恢复方面两种治疗方法差异有显著性意义(MD=3.67，95%CI=1.40，5.94；P=0.002)(图9)。对此进行敏感性分析后发现，剔除任一项研究，各合并效应量仍有统计学差异，且森林图方向未改变，说明该研究结果稳定。可见经皮椎体后凸成形组治疗后椎体前缘高度的恢复程度明显高于经皮椎体成形组。 2.3.6 改善后凸角差异有3个研究对于两种治疗方法在治疗后短期内后凸角恢复效果进行了调查[27-28，30]。研究间存在异质性(P<0.000 3，I2=87%)，采用随机效应模型合并分析。Meta分析结果表明：经皮椎体后凸成形组及经皮椎体成形组治疗后短期内减小后凸角差异无显著性意义(MD=2.25，95%CI=-5.14，0.65；P=0.13)(图10)。敏感性分析结果示，剔除任一项研究，各合并效应量均无统计学差异，且森林图方向未改变，说明该研究结果稳定。有5个研究提供了治疗后长期后凸角的变化[21-22，28，30-31]。研究间存在异质性(P < 0.000 1，I2=84%)，采用随机效应模型合并分析。Meta分析结果表明：两种方法治疗后远期改善后凸角差异有显著性意义(MD=-3.29，95%CI=-5.26，-1.32；P=0.001)(图11)。经皮椎体后凸成形组治疗后长期改善后凸角的程度明显高于经皮椎体成形组。敏感性分析结果示，剔除任一项研究，各合并效应量仍有统计学差异，且森林图方向未改变，说明该研究结果稳定。 2.3.7 手术所需时间的差异有2个研究记录了两种治疗方法所需要的手术时间[21，32]。研究间存在异质性(P < 0.004，I2=88%)，采用随机效应模型合并分析Meta分析结果显示，经皮椎体后凸成形组及经皮椎体成形组手术所需时间差异无显著性意义(MD=4.47，95%CI=-0.22，9.17；P=0.06)(图12)。"

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