Chinese Journal of Tissue Engineering Research ›› 2020, Vol. 24 ›› Issue (33): 5397-5404.doi: 10.3969/j.issn.2095-4344.2346

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Efficacy and safety of percutaneous kyphoplasty versus posterior short-segment fixation with vertebra augmentation for Kummell’s disease: a meta-analysis

Zhan Fangbiao1, Xie Lizhong1, Zou Xinsen2, Long Jie1, Cheng Jun1, Zhang Xianwei3   

  1. 1Department of Orthopedics, 2Intensive Care Unit, 3Department of Sleep Medicine, Three Gorges Hospital (Chongqing Three Gorges Central Hospital), Chongqing University, Chongqing 404000, China

  • Received:2020-02-10 Revised:2020-02-18 Accepted:2020-03-18 Online:2020-11-28 Published:2020-10-15
  • Contact: Cheng Jun, Associate chief physician, Department of Orthopedics, Three Gorges Hospital (Chongqing Three Gorges Central Hospital), Chongqing University, Chongqing 404000, China Zhang Xianwei, Attending physician, Department of Sleep Medicine, Three Gorges Hospital (Chongqing Three Gorges Central Hospital), Chongqing University, Chongqing 404000, China
  • About author:Zhan Fangbiao, Doctoral candidate, Associate chief physician, Department of Orthopedics, Three Gorges Hospital (Chongqing Three Gorges Central Hospital), Chongqing University, Chongqing 404000, China

Abstract:

BACKGROUND: Because the single percutaneous kyphoplasty for treating Kummell’s disease brought the uneven distribution and displacement of bone cement. Current research has recommended a posterior short-segmental fixation combined with vertebra cement augmentation for Kummell’s disease.

OBJECTIVE: To evaluate the effectiveness and safety of percutaneous kyphoplasty or posterior short-segmental fixation combined with vertebral body bone cement augmentation for Kummell’s disease using meta-analysis.

METHODS: PubMed, the Cochrane Library, Web of Science database, EMBASE, Chinese biomedical literature database, China National Knowledge Infrastructure, VIP and Wanfang database were retrieved for randomized controlled trials, case-control studies and cohort studies regarding percutaneous kyphoplasty and posterior short-segmental fixation combined with vertebra bone cement augmentation (posterior spinal fixation + bone cement) for Kummell’s disease. The retrieval period was from the database establishment to February 1, 2020, and the retrieval languages were Chinese and English. All the retrieved literature was screened according to inclusion and exclusion criteria by two reviewers. NOS scale was used to evaluate the literature quality, and then Review Manager 5.3 software was used for meta-analysis.

RESULTS AND CONCLUSION: (1) Four articles were finally included, with 200 patients, including 108 in the percutaneous kyphoplasty group and 92 in the posterior spinal fixation + bone cement group. (2) Meta-analysis showed that operation time was significantly shorter and intraoperative blood loss was less in the percutaneous kyphoplasty group than in the posterior spinal fixation + bone cement group [MD=-82.83, 95%CI(-144.43, -21.24), Z=2.64, P=0.008; MD=-204.44, 95%CI(-210.97, -197.92), Z=61.43, P < 0.000 01]. Incidence of perioperative complications was lower in the percutaneous kyphoplasty group than in the posterior spinal fixation + bone cement group [OR=0.15, 95%CI(0.03, 0.91), Z=2.07, P=0.04]. Incidence of bone cement leakage was higher in the percutaneous kyphoplasty group than in the posterior spinal fixation + bone cement group [RR=1.99, 95%CI(1.03, 3.88), Z=2.03, P=0.04]. There were no significant differences in visual analogue scale score, Oswestry disability index and kyphosis angle between the two groups in the last follow-up (P > 0.05). (3) The results suggest that percutaneous kyphoplasty and posterior spinal fixation + bone cement are effective and safe in the treatment of Kummell’s disease. Percutaneous kyphoplasty can reduce the operation time, intraoperative blood loss and perioperative complications. The two methods have their own advantages and disadvantages, which should be selected by clinicians according to the individual situation of patients.

Key words: bone, Kummell’s disease, bone cement, internal fixation, minimally invasive, vertebroplasty, meta-analysis

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