Meta-analysis of efficacy and safety of bone filling bag vertebroplasty and percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fracture#br#

doi:10.3969/j.issn.2095-4344.3792

Abstract

Abstract: OBJECTIVE: It remains disputed whether there is a difference in efficacy and safety between bone filling bag vertebroplasty and percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fracture. This study systematically analyzed the efficacy and safety of bone filling bag vertebroplasty and percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fracture.
METHODS: A computer-based online search of CNKI, Wanfang, VIP, EMBASE, PubMed, CBM, and The Cochrane library was performed to retrieve randomized controlled trial studies and cohort studies regarding bone filling bag vertebroplasty and percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fracture published before March 2020. Moreover, related papers were retrieved manually. After two evaluators independently selected literature, extracted data and evaluated the quality of methodology included in the study, meta-analysis was carried out by using Stata/SE 12.0 software.
RESULTS: (1) A total of seven articles were included, with 709 patients, of whom 321 were treated with bone filling bag vertebroplasty and 388 with percutaneous vertebroplasty. The quality of the two randomized controlled trials was grade B. The scores of NOS in two cohort studies were 8. The other three cohorts scored 7 on the NOS scale. (2) The meta-analysis results showed that there were significant differences between the two methods in reducing Cobb angle (MD=-1.92, 95%CI:-2.15 to -1.68, P < 0.05) and the leakage rate of bone cement (RR=0.15, 95%CI:0.07-0.30, P < 0.05). There was no significant difference between the two methods in reducing visual analogue scale score (MD=-0.03, 95%CI:-0.12-0.06, P=0.521) and Oswestry disability index (MD=0.16, 95%CI:-0.93-1.26, P=0.770).
CONCLUSION: Compared with the conventional percutaneous vertebroplasty, bone filling bag vertebroplasty has a significant advantage in improving Cobb angle and reducing the leakage rate of bone cement. The clinical therapeutic effects of the two methods are similar in visual analogue scale score and Oswestry disability index. In view of the limited quality of the included literature, more high-quality multicenter randomized controlled trials are needed to provide evidence support for the above conclusion.

Key words: bone, vertebral body, bone cement, osteoporosis, pain, vertebral fracture, vertebroplasty, meta-analysis

CLC Number:

Zhong Yuanming, Wan Tong, Zhong Xifeng, Wu Zhuotan, He Bingkun, Wu Sixian. Meta-analysis of efficacy and safety of bone filling bag vertebroplasty and percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fracture#br#[J]. Chinese Journal of Tissue Engineering Research, 2021, 25(12): 1930-1935.

Figures/Tables 7

References

[1] 杨九杰,赵伟,王楠,等.脂肪间充质干细胞成骨分化条件培养基联合骨形态发生蛋白2治疗去卵巢大鼠骨质疏松症[J].中国组织工程研究, 2020,24(1):7-13.
[2] MALIK AT, RETCHIN S, PHILLIPS FM, et al. Declining trend in osteoporosis management and screening following vertebral compression fractures - a national analysis of commercial insurance and medicare advantage beneficiaries. Spine J. 2020; 20(4):538-546.
[3] SHIGENOBU K, HASHIMOTO T, KANAYAMA M, et al. The efficacy of osteoporotic treatment in patients with new spinal vertebral compression fracture pain, ADL, QOL, bone metabolism and fracture-healing-In comparison with weekly teriparatide with bisphosphonate. Bone Rep. 2019;11:100217.
[4] ORHURHU V, AGUDILE E, CHU R, et al. Socioeconomic disparities in the utilization of spine augmentation for patients with osteoporotic fractures: an analysis of National Inpatient Sample from 2011 to 2015. Spine J. 2020;20(4):547-555.
[5] 李凡杰,杜怡斌,刘艺明,等.椎体成形与弯角椎体成形治疗骨质疏松性椎体压缩骨折:骨水泥注射后分布与渗漏率的比较[J].中国组织工程研究,2020,24(10):1484-1490.
[6] POURTAHERI S, LUO W, CUI C, et al. Vertebral augmentation is superior to nonoperative care at reducing lower back pain for symptomatic osteoporotic compression fractures. Clin Spine Surg. 2018;31(8):339-344.
[7] HUANG S, ZHU X, XIAO D, et al. Therapeutic effect of percutaneous kyphoplasty combined with anti-osteoporosis drug on postmenopausal women with osteoporotic vertebral compression fracture and analysis of postoperative bone cement leakage risk factors: a retrospective cohort study. J Orthop Surg Res. 2019;14(1):1-12.
[8] BALÁZSFI M, KIS D, TÓTH T, et al. Radiofrequency facet joint denervation efficiency based on the severity of spondylarthrosis and in osteoporotic vertebral compression fractures. A retrospective study. Clin Neurol Neurosurg. 2019;186:105497.
[9] OH Y, LEE B, LEE S, et al. Percutaneous vertebroplasty versus conservative treatment using a transdermal fentanyl patch for osteoporotic vertebral compression fractures. J Korean Neurosurg Soc. 2019;62(5):594.
[10] XIE L, ZHAO ZG, ZHANG SJ, et al. Percutaneous vertebroplasty versus conservative treatment for osteoporotic vertebral compression fractures: an updated meta-analysis of prospective randomized controlled trials. Int J Surg. 2017;47:25-32.
[11] KHAN M, KUSHCHAYEV SV. Percutaneous vertebral body augmentations: the state of art. Neuroimaging Clin N Am. 2019;29(4):495-513.
[12] ZUO XH, ZHU XP, BAO HG, et al. Network meta-analysis of percutaneous vertebroplasty, percutaneous kyphoplasty, nerve block, and conservative treatment for nonsurgery options of acute/subacute and chronic osteoporotic vertebral compression fractures (OVCFs) in short-term and long-term effects. Medicine (Baltimore). 2018;97(29):e11544.
[13] ALHASHASH M, SHOUSHA M, BARAKAT AS, et al. Effects of polymethylmethacrylate cement viscosity and bone porosity on cement leakage and new vertebral fractures after percutaneous vertebroplasty: a prospective study. Global Spine J. 2019;9(7):754-760.
[14] KLINGLER JH, SIRCAR R, DEININGER MH, et al. Vesselplasty: a new minimally invasive approach to treat pathological vertebral fractures in selected tumor patients-preliminary results. Rofo. 2013;185(4):340-350.
[15] 印平,马远征,马迅,等.骨质疏松性椎体压缩性骨折的治疗指南[J].中国骨质疏松杂志,2015, 21(6):643-648.
[16] 李东华,刘训伟,彭湘涛,等.骨填充网袋灌注骨水泥修复椎体压缩骨折:可降低骨水泥椎体外渗漏率[J].中国组织工程研究,2015,19(3):358-363.
[17] 李斌田. PVP、PKP、扩张型编织囊袋椎体后凸成形术在治疗新鲜胸腰椎骨质疏松性压缩骨折的临床疗效分析[D].济南:山东中医药大学,2016.
[18] 王永虎.网袋椎体成形术与常规PVP手术治疗骨质疏松性椎体压缩骨折的疗效对比[J].颈腰痛杂志,2018,39(6):745-747.
[19] 姜树东,洪毅,张军卫,等.椎体成形与网袋成形治疗骨质疏松性骨折早期效果比较[J].中国矫形外科杂志,2019,27(4):289-293.
[20] CHEN C, LI D, WANG Z, et al. Safety and efficacy studies of vertebroplasty, kyphoplasty, and mesh-container-plasty for the treatment of vertebral compression fractures: preliminary report. PLoS One. 2016;11(3):e0151492.
[21] 徐龙,辛健.PVP、PKP、囊袋治疗新鲜骨质疏松性椎体压缩骨折的临床分析[J].中国矫形外科杂志,2019,27(19):1812-1815.
[22] 高志祥,李淳,李磊,等.PVP、PKP、骨填充网袋治疗胸腰段骨质疏松性椎体压缩性骨折的疗效分析[J].实用骨科杂志, 2017,23(8):680-683, 697.
[23] YANG S, CHEN C, WANG H, et al. A systematic review of unilateral versus bilateral percutaneous vertebroplasty/percutaneous kyphoplasty for osteoporotic vertebral compression fractures. Acta Orthop Traumatol Turc. 2017;51(4):290-297.
[24] LI HM, ZHANG RJ, GAO H, et al. New vertebral fractures after osteoporotic vertebral compression fracture between balloon kyphoplasty and nonsurgical treatment PRISMA. Medicine. 2018; 97(40):e12666.
[25] SUN X, LIU X, WANG J, et al. The effect of early limited activity after bipedicular percutaneous vertebroplasty to treat acute painful osteoporotic vertebral compression fractures. Pain Physician. 2020;23(1):E31-E40.
[26] JACOBS E, SENDEN R, MCCRUM C, et al. Effect of a semirigid thoracolumbar orthosis on gait and sagittal alignment in patients with an osteoporotic vertebral compression fracture. Clin Interv Aging. 2019;14:671-680.
[27] CHEN YC, ZHANG L, LI EN, et al. Unilateral versus bilateral percutaneous vertebroplasty for osteoporotic vertebral compression fractures in elderly patients: a meta-analysis. Medicine. 2019; 98(8):e14317.
[28] ZHANG Z, JIAO F, HUANG H, et al. A second puncture and injection technique for treating osteoporotic vertebral compression fractures. J Orthop Surg Res. 2019;14(1):1-7.
[29] ZHU RS, KAN SL, NING GZ, et al. Which is the best treatment of osteoporotic vertebral compression fractures: balloon kyphoplasty, percutaneous vertebroplasty, or non-surgical treatment? A Bayesian network meta-analysis. Osteoporos Int. 2019;30(2):287-298.
[30] LI J, LIN JS, XU JC, et al. A novel approach for percutaneous vertebroplasty based on preoperative computed tomography–based three-dimensional model design. World Neurosurg. 2017;105:20-26.
[31] ZHU Y, CHENG J, YIN J, et al. Therapeutic effect of kyphoplasty and balloon vertebroplasty on osteoporotic vertebral compression fracture: A systematic review and meta-analysis of randomized controlled trials. Medicine. 2019; 98(45):e17810.
[32] GUO D, YU M, ZHANG S, et al. Novel Surgical Strategy for Treating Osteoporotic Vertebral Fractures with Cord Compression. Orthop Surg. 2019;11(6):1082-1092.
[33] YANG J. Correlation between the distribution of bone cement and clinical efficacy in the treatment of osteoporotic spinal fractures with percutaneous vertebroplasty. Zhongguo Gu Shang. 2019;32(12):1128.
[34] TIAN J, XIANG L, ZHOU D, et al. The clinical efficacy of vertebroplasty on osteoporotic vertebral compression fracture: a meta-analysis. Int J Surg. 2014;12(12):1249-1253.
[35] ZHOU X, MENG X, ZHU H, et al. Early versus late percutaneous kyphoplasty for treating osteoporotic vertebral compression fracture: a retrospective study. Clin Neurol Neurosurg. 2019;180:101-105.
[36] YEH KL, WU SH, WU SS, et al. Rare episode of cement leakage during vesselplasty in a case of vertebral compression fracture. World Neurosurg. 2020;137:416-420.
[37] FUSCO A. Benefits and harms of percutaneous vertebroplasty for the treatment of osteoporotic vertebral compression fracture: a cochrane review summary with commentary. Am J Phys Med Rehabil. 2019;98(12):1151-1152.
[38] WANG B, ZHAO CP, SONG LX, et al. Balloon kyphoplasty versus percutaneous vertebroplasty for osteoporotic vertebral compression fracture: a meta-analysis and systematic review. J Orthop Surg Res. 2018;13(1):264.
[39] FLORS L, LONJEDO E, LEIVA-SALINAS C, et al. Vesselplasty: a new technical approach to treat symptomatic vertebral compression fractures. Am J Roentgenol. 2009;193(1):218-226.
[40] DUAN ZK, ZOU JF, HE XL, et al. Bone-filling mesh container versus percutaneous kyphoplasty in treating Kümmell’s disease. Arch Osteoporos. 2019;14(1):109.
[41] ZHONG R, LIU J, WANG R, et al. Unilateral curved versus bipedicular vertebroplasty in the treatment of osteoporotic vertebral compression fractures. BMC Surg. 2019;19(1):193.