A meta-analysis of unilateral versus bilateral balloon kyphoplasty in the treatment of osteoporotic vertebral compression fractures

doi:10.3969/j.issn.2095-4344.2014.34.027

Abstract

Abstract:

BACKGROUND: Balloon kyphoplasty is effective in the treatment of osteoporotic vertebral compression fractures, but it is unclear that which one is proper, unilateral or bilateral approach, with better efficacy and fewer complications.

OBJECTIVE: To assess the efficacy and safety of unilateral versus bilateral balloon kyphoplasty in the treatment of osteoporotic vertebral compression fractures.

METHODS: We searched the electronic bibliographic databases including Cochrane Library, PubMed, EMBASE, ISI Web of Knowledge, CBMdisc and other databases to collect clinical trials concerning unilateral versus bilateral balloon kyphoplasty. Two estimators independently evaluated the quality of these included studies and analyzed data by Cochrane Collaboration’s RevMan 5.2 software.

RESULTS AND CONCLUSION: Fourteen trials involving 876 patients were included. There were 442 cases of unilateral approach and 434 of bilateral approach. The meta-analysis showed that there were no significant differences in pain score by visual analog scale, vertebral height, and kyphotic angle; while the unilateral approach had less operating time, lower amount of cement injected and lower risk of cement leakage than the bilateral approach [mean difference (MD)=-19.33, 95% confidence interval (CI) (-24.42, -14.24); MD=-2.07, 95% CI (-2.42, -1.71); odds ratio=0.47, 95% CI (-24.42, -14.240)]. These findings indicate that the unilateral balloon kyphoplasty can reduce the leakage rate of bone cement.

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

全文链接：

Key words: osteoporotic fractures, vertebroplasty, meta-analysis

CLC Number:

R318

Ma Gui-fu, Qian Yao-wen, Liu Lin, Luo Wen-yuan, Liu Shao-guang. A meta-analysis of unilateral versus bilateral balloon kyphoplasty in the treatment of osteoporotic vertebral compression fractures[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(34): 5566-5571.

Figures/Tables 1

2.1 检索结果和纳入研究的一般特征根据制定的检索策略共检索到文献495篇，排除重复文献167篇和不相关及综述186篇，初步纳入文献142篇；通过阅读全文，排除非对照试验和不符合纳入标准的文献136篇，最终纳入14篇文献[15-17，19-29]。14个研究共纳入患者876例，单侧椎体后凸成形组442例，双侧椎体后凸成形组434例。纳入研究的基本特征见表1。 2.2 纳入研究的质量评价纳入的14个研究中，均未描述具体的随机方法，纳入的研究也未描述是否对分配方案进行隐藏和是否实施盲法，见表2。 2.3 Meta分析结果 2.3.1 目测类比评分 14个研究报道了目测类比评分[15-17，19-29]。Meta分析结果显示两种入路方法在术后1周、1年和2年的目测类比评分差异无显著性意义[MD1周= 0.17，95%CI (-0.11, 0.44)；MD1年=0.01，95%CI (-0.29, 0.32)；MD2年=0.28，95%CI (-0.13, 0.70)]，见表3。 2.3.2 Cobb角变化 10个研究报道了Cobb角的变化[15-17，21，23-28]。Meta分析结果显示两者的差异无显著性意义[MD=-0.02，95%CI (-0.65, 0.61)]，见表3。 2.3.3 椎体高度变化 7个研究报道了椎体高度变化[15-17，23-25，28]。各研究间差异无统计学异质性(P=0.54，I2= 0%)，采用固定效应模型，Meta结果显示两种入路在改变椎体高度方面差异无显著性意义[MD=-0.13，95%CI (-0.32, 0.06)]，见表3。 2.3.4 单个椎体平均注射骨水泥 10个研究报道了单个椎体平均注射骨水泥[15-17，21-25，28-29]。各研究间无统计学异质性(P=0.10，I2=38%)，采用固定效应模型，Meta分析结果显示单侧椎体后凸成形可减少单个椎体注射骨水泥的量[MD=-2.07，95%CI (-2.42, -1.71)]，见表3。 2.3.5 手术时间 12个研究报道了平均手术的时间[15-17，19-25，28-29]。各研究间差异无统计学异质性(P=0.13，I2=32%)，采用固定效应模型，Meta分析结果显示单侧椎体后凸成形可缩短手术时间[MD=-19.33，95%CI (-24.42， -14.24)]，见表3。 2.3.6 骨水泥渗漏 6个研究报道了骨水泥渗漏[15-17，21，24-25]。各研究间无统计学异质性(P=0.23，I2= 27%)，采用固定效应模型，Meta结果显示单侧椎体后凸成形可以减少骨水泥渗漏发生的概率[OR=0.47，95%CI (0.24，0.92)]，见表3。"

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