A Meta-analysis on percutaneous vertebroplasty with high-viscosity and low-viscosity bone cement for osteoporotic vertebral compression fractures

doi:10.3969/j.issn.2095-4344.2017.34.026

Abstract

Abstract:

BACKGROUND: Percutaneous vertebroplasty (PVP) has been proved to be effective for osteoporotic vertebral compression fractures (OVCF); however, bone cement leakage-related complications occur frequently.

OBJECTIVE: To systematically evaluate the safety and complications of PVP with high-viscosity and low-viscosity bone cement in the treatment of OVCF.

METHODS: We performed a systematic search by computer in PubMed, EMBASE, Cochrane Library (December, 2016) and CNKI, CBM, VIP and WanFang databases from January, 2000 to December, 2016; meanwhile, the relevant Chinese and English orthopedic journals were retrieved manually. Randomized controlled trials (RCTs) concerning the use of high-viscosity and low-viscosity bone cement in the PVP for OVCF were collected and systematically reviewed using the method recommended by the Cochrane Collaboration. The Meta-analysis was performed by using the RevMan5.2.

RESULTS AND CONCLUSION: Six relevant RCTs were included, involving 554 patients (high-viscosity bone cement was used in 278 cases and low-viscosity bone cement in 276 cases). Meta-analysis results showed that postoperative pain symptoms were alleviated in all the 554 cases, and there was no significant difference in the amount of adjacent vertebral fractures between two approaches (P > 0.05). However, there was a significant difference in the visual analog scale score, Oswestry disability index value, Cobb angle, and bone cement leakage rate between high-viscosity and low-viscosity cement groups (P < 0.05). To conclude, PVP with either high-viscosity or low-viscosity bone cement can relieve pain rapidly in OVCF patients, and both approaches are safe and effective. However, high-viscosity bone cement has a lower cement leakage rate and better outcomes in visual analog scale score, Oswestry disability index, Cobb angle and cement leakage prevention as compared with low-viscosity 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

Key words: Vertebroplasty, Osteoporosis, Fractures, Compression, Evidence-Based Medicine, Tissue

CLC Number:

R318

Xu Min, Zhang Hong-sheng, Wang Ji, Tang Fu-yu, Huang Cheng-jun, Liang Dong-bo, Xue Hong, Xu Bao-shan.

A Meta-analysis on percutaneous vertebroplasty with high-viscosity and low-viscosity bone cement for osteoporotic vertebral compression fractures

[J]. Chinese Journal of Tissue Engineering Research, 2017, 21(34): 5571-5576.

Figures/Tables 7

References

[1]Kim KW,Cho KJ,Kim SW,et al.A nation-wide, outpatient-base survey on the pain, disability, and satisfaction of patients wit osteoporotic vertebral compression fractures.Asian Spine J. 2013;7(4):301-307.

[2]王岩. 骨质疏松性椎体压缩骨折的微创治疗[J].中华创伤骨科杂志, 2001,6(9):995-998.

[3]Hasserius R, Karlsson MK, Jonsson B ,et al. Long-term morbidity and mortality after a clinically diagnosed vertebral fracture in the elderly-a 12 and 22-year followup of 257 patients. Calcif Tissue In. 2005;76: 235-242.

[4]Anderson PA, Frtoyshteter AB, Tontz WL, et al. Meta analysis of vertebral augmentation compared with conservative treatment for osteoporotic spinal fractures. J Bone Miner Res. 2013;28( 2) : 372-382.

[5]霍柱根,丘青中,李剑,等. 经皮椎弓根钉内固定治疗骨质疏松性椎体压缩骨折[J].医药与保健,2014,22(2): 28-31.

[6]高军伟,孙常太. 椎体加强术在治疗骨质疏松性椎体压缩骨折方面的临床应用[J].脊柱外科杂志,2014,12(5): 317-320.

[7]宋仁谦,周英杰,赵刚,等.高黏度骨水泥经皮椎体成形术与经皮疗骨质疏松压缩骨折的临床疗效观察[J].中国矫形外科杂志, 2016, 24(8):692-696.

[8]柳申鹏,刘中何,赵斌,等.骨水泥植入经皮椎体成形治疗胸腰椎体骨折[J].中国组织工程研究,2012,16(29):5465-5468.

[9]张愈峰,龚辉,侍德.过伸体位复位联合Confidence 高黏度椎体骨水泥椎体成形术治疗椎体骨质疏松压缩性骨折[J].中国矫形外科杂志,2016,24(2):110-113.

[10]彭小忠,陈明,武振国,等.经皮椎体成形102例中22例骨水泥渗漏原因[J].中国组织工程研究与临床康复, 2011,15(8): 1515-1518.

[11]李春海,刘尚礼,叶伟,等.高黏度骨水泥在经皮椎体成形术中的应用[J].中华骨科杂志,2007,27(4):259-262．

[12]冯新民,王静成,张亮,等. 高黏度骨水泥在修复骨质疏松性胸腰椎骨折中的应用[J]. 中国组织工程研究,2014,18(30): 4757-4763.

[13]Anselmetti GC, Zoarski G, Manca A, et al. Percutaneous vertebroplasty and bone cement leakage: clinical experience with a new high-viscosity bone cement and delivery system for vertebral augmentation in benign and malignant compression fractures. Cardiovasc Intervent Radiol. 2008;31(5):937-947.

[14]李静,秦莉,刘鸣.系统评价的基本方法[J].中国循证医学,2011, 1(1): 34-38.

[15]Sackett DL, Rosenberg WM. Evidence Based Medicine:What It Is and What It Isn’t. BMJ. 1996;312(7023):71-72.

[16]Higgins JP, Thompson SG. Controlling the Risk of Spurious Findings from Meta- regression. Stal Med. 2004;23(11): 1663-1682.

[17]Krieg JC. Proximal tibial fractures: current treatment, results and problems. Injury. 2003;34(1):2-10.

[18]李静,李幼平.不断完善与发展的Cochrane系统评价[J]. 中国循证医学杂志, 2008, 8(9): 742-743.

[19]徐超,伊力哈木.托合提,李国华,等.高粘度与低粘度骨水泥PVP治疗骨质疏松椎体压缩骨折的疗效和并发症[J].中国脊柱脊髓杂志,2014,24(10):900-905.

[20]朱世卿,周传礼,程永生,等.高黏度骨水泥经皮椎体成形术对绝经骨质疏松压缩骨折的疗效评价[J].临床与病理杂志,2016,36(9): 1297-1303.

[21]李建赤,黄必留,谭加群,等.高黏度骨水泥经皮椎体成形术治疗骨质疏松性椎体压缩骨折的临床研究[J].中华骨与关节外科杂志, 2016,9(4):317-321.

[22]曾日祥,马勇,邓颂波,等.高粘度骨水泥治疗骨质疏松性椎体压缩性骨折效果观察[J].赣南医学院学报,2016,36(2):221-224.

[23]梅启元,邵琳.高黏度骨水泥经皮椎体成形术治疗老年骨质疏松椎体压缩性骨折[J].中国疗养医学,2016,25(4):379-381.

[24]郭永贤,宋世江,王娟,等.骨质疏松椎体压缩性骨折患者经皮椎形术中应用不同黏度骨水泥效果比较[J].山东医药, 2016,56(32): 51-53.

[25]董继胜,董力军, 闫兵勇,等.经皮椎体成形术和经皮椎体后凸成形术治疗老年骨质疏松椎体压缩性骨折的疗效观察[J].中国矫形外科杂志,2015,23(8): 748-751.

[26]黄袁迟,邹德威,马华松,等.骨质疏松椎体压缩性骨折的微创治疗[J].中国矫形外科杂志,2011,19(10): 824-826.

[27]徐建成,白靖平,锡林宝勒日,等.注入骨水泥椎体成形与非手术治疗骨质疏松性椎体压缩骨折的Meta分析[J].中国组织工程研究与临床康复,2011,15(13):2366-2370.

[28]史光华,李鹏翠,卫小春.骨质疏松椎体压缩骨折的治疗进展[J].中国骨伤, 2013,26(10):878-882.

[29]Wu ZX,Gao MX,Sang HX,et al.Surgical treatment of osteoporotic thoracolumbar compressive fractures with open vertebral cement augmentation of expandable pedicle screw fixation: a biomechanical study and a 2-year follow-up of 20 patients. J Surg Res.2012;173(1):91-98.

[30]Hulme PA,Krebs J,Ferguson SJ,et al.Vertebroplasty and kyphoplasty: a systematic review of 69 clinical studies.Spine (Phila Pa 1976).2006;31(17):1983-2001.

[31]Venmans A,Lohle P,Van Rooij W,et al.Frequency and outcome of pulmonary polymethylmethacrylate embolism during percutaneous vertebroplasty.AJNR Am J Neuroradiol. 2008;29(10):1983-1985.