Unipedicular versus bipedicular percutaneous kyphoplasty for treating osteoporotic vertebral compression fractures: a meta-analysis

doi:10.3969/j.issn.2095-4344.2014.31.019

Abstract

Abstract:

BACKGROUND: Percutaneous kyphoplasty, as a kind of minimally invasive surgery, has been proved to be effective in the treatment of osteoporotic vertebral compression fractures. Percutaneous kyphoplasty has simple operation and safe mode, can relieve pain quickly, and obviously restore vertebral body height. However, the therapeutic effects of unipedicular and bipedicular percutaneous kyphoplasty for osteoporotic vertebral compression fractures are controversial.
OBJECTIVE: To analyze controlled trials on the therapy with unipedicular and bipedicular percutaneous kyphoplasty using meta-analysis, and to compare the effectiveness and superiority of the two methods with a large sample size.
METHODS: We retrieved PubMed, Web of Knowledge, China Journal Full-text database, Wanfang database, and Super Star database for articles on meta-analysis of unipedicular versus bipedicular percutaneous kyphoplasty published from 2000 to 2014 in Chinese and English. Unipedicular percutaneous kyphoplasty served as experimental group and bipedicular percutaneous kyphoplasty as control group. Curative effect and the difference between evaluation indexes were expressed as the weighted mean difference and 95% confidence interval and the RR value. Statistical analysis was carried out using Review Manager 5.2 software.
RESULTS AND CONCLUSION: A total of seven randomized controlled trials were collected. Results of statistical analysis showed that visual analogus scale scores were decreased in both groups, but no significant difference was detected [RR= -0.08, 95%CI(-0.05, -0.21), P=0.21]. There was no significant difference in Cobb angle change [RR= -0.07, 95%CI(-0.16, -1.47), P=0.93]. No significant difference in the average recovered height of vertebral bodies was detected [RR=-1.76, 95%CI(-4.21, -0.69), P=0.16]. Operation time was shorter in unipedicular percutaneous kyphoplasty than in bipedicular percutaneous kyphoplasty [RR= -23.99, 95%CI(-26.01, -21.97), P < 0.000 01]. These data indicated that compared with bipedicular percutaneous kyphoplasty, unipedicular percutaneous kyphoplasty could effectively reduce the operation time. However, no significant difference in visual analogus scale scores, Cobb angle change and the average recovered height of vertebral bodies was visible in statistical analysis in both groups.

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: kyphoplasty, fractures, compression, osteoporosis, meta-analysis

CLC Number:

R318

Yin Le-le, Xu Xiao-xiong, Pan Qi-lin, Zuo Kang-kang. Unipedicular versus bipedicular percutaneous kyphoplasty for treating osteoporotic vertebral compression fractures: a meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(31): 5030-5035.

Figures/Tables 2

2.1 原始资料数量和质量共检索到423篇相关文献，手工检索未检出相关文献，阅读文题和摘要排除相同和无关文献后共纳入17篇文献，进行一步阅读全文后共有7篇符合文献符合纳入标准[16-22]，其中英文文献5篇，中文文献2篇，各文献纳入人数36-127不等，共计人数416例，其中试验组229例，对照组187例。两名作者根据改良的Jadad量表分别对纳入的文献进行评分，最后达成一致结果。从是否采用随机分配的对照试验；是否采用盲法；是否运用随机隐藏；是否对病例中的退出及失访进行描述等4方面进行文献评价；纳入的7篇文献中高质量4篇，低质量3篇，根据Cochrane的文献评价标准，都属于B级文献，见表1。 2.2 纳入文献临床试验及Meta分析结果 2.2.1 应用单侧经皮椎体后凸成形和双侧经皮椎体后凸成形治疗的手术时间比较符合单侧经皮椎体后凸成形和双侧经皮椎体后凸成形治疗手术时间比较的文献有5篇[18-22]，异质性检验结果示：P=0.002，存在异质性(P < 0.1)，故采用随机效应模型，Meta分析结果显示单侧经皮椎体后凸成形术比双侧经皮椎体后凸成形术的手术时间短，差异具有显著性意义(P < 0.000 01), 5篇文献的 RR值95%CI分别为-25.52(-28.02，-23.02)，-23.21(-27.39，-19.03)，-33.00(-50.00，-16.00)，-23.80(-33.53，-14.07)，-8.00(-16.35，-0.35)，合并后的RR值和95%CI为-23.99(-26.01，-21.97)，菱形位于垂直线的左侧，根据森林图示：5篇纳入文献的95%CI均跨过垂直线，其差异无显著性意义(P > 0.05)，合并后的95%CI位于垂直线的左侧，经Z检验单侧经皮椎体后凸成形和双侧经皮椎体后凸成形治疗比较，手术时间比较差异有显著性意义(P < 0.000 01)，再结合RR值可说明单侧经皮椎体后凸成形治疗的手术时间比双侧经皮椎体后凸成形治疗短，见图1。 2.2.2 应用单侧经皮椎体后凸成形和双侧经皮椎体后凸成形治疗的目测类比评分比较符合单侧经皮椎体后凸成形和双侧经皮椎体后凸成形治疗目测类比评分标准的文献共有7篇[16-22]，异质性检验结果为P=0.86，不存在异质性(P > 0.1)，因此采用固定效应模型分析，Meta分析结果显示单侧经皮椎体后凸成形与双侧经皮椎体后凸成形治疗的目测类比评分差异无显著意义(P=0.21)，7篇文献的的RR值和95%CI分别为0.06(-0.50，0.62)，-0.16(-0.94，0.62)，0.40(-0.66，1.46)，0.40(-0.83，1.63)，-0.39(-1.21，0.43)，-1.10(-0.85，0.65)，0.10(-0.04，0.24)。上述结果显示7篇文献的RR值和95%CI都在垂直线周围，其差异无显著性意义(P > 0.05)，合并后的 95%CI位于垂直线的中央，经Z检验单侧经皮椎体后凸成形和双侧经皮椎体后凸成形治疗比较目测类比评分差异无显著性意义(P=0.21)，说明单侧经皮椎体后凸成形与双侧经皮椎体后凸成形治疗对疼痛的缓解无明显差异，见图2。 2.2.3 应用单侧经皮椎体后凸成形和双侧经皮椎体后凸成形治疗椎体平均高度恢复率比较符合单侧经皮椎体后凸成形和双侧经皮椎体后凸成形治疗椎体平均高度恢复率比较的文献共有2篇[18，22]，异质性检验结果为P=0.02，存在异质性(P < 0.1)，故采用随机效应模型，Meta分析结果显示单侧经皮椎体后凸成形与双侧经皮椎体后凸成形治疗椎体平均高度恢复率差异无显著意义(P=0.54)，2篇文献的的RR值和95%CI分别为-6.48(-12.69，-0.27)，4.10 (-2.37，10.57)。上述结果显示2篇文献的RR值和95%CI都在垂直线周围，其差异无显著性意义(P > 0.05)，合并后的95%CI位于垂直线的中央，经Z检验单侧经皮椎体后凸成形和双侧经皮椎体后凸成形治疗椎体平均高度恢复率差异无显著性意义(P=0.54)，见图3。"

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